What routes of challenge are available to an insurer’s rejection of my business interruption claim?
Many policies will only provide business interruption cover if it arises from property damage. The FCA has acknowledged that insurers are entitled to reject claims in relation to such policies, notwithstanding the success of the FCA’s test case in the Supreme Court, and which was generally favourable to policyholders [Insert a link here to our update on the test case]. In other cases the policy wording will be less clear and businesses may legitimately feel that their insurer is wrongly withholding payment.
One route of challenge to an insurer’s decision is via one of the well-publicised class actions. Another route of challenge is by a complaint to the Financial Ombudsman Service (FOS). This service is open to consumers and small and medium-sized businesses, ‘micro-enterprises’, charities and trusts. The service will be an attractive option for many businesses, as it is free and relatively quick (although it remains to be seen how the service keeps up with an increase in demand as a result of the pandemic). You will need to have complained to your insurer before bringing a complaint with the FOS.
Further details can be found here.
Related FAQs
Unfortunately, losses caused by pandemics are not often covered expressly under standard policies, as the risk has been difficult for insurers to price and understand.
Even where additional cover in respect of notifiable diseases has been purchased, it typically will not include Covid-19 within the range of diseases covered by the policy. If the policy includes a list of notifiable diseases, and which does not include Covid-19, it is very unlikely that cover will be available for pandemic-relates losses.
The most common types of covers that could be afforded by insurance policies for coronavirus-related losses and liabilities are traditional business interruption insurance, contingent business interruption insurance, liability insurance, as well as cancellation and abandonment insurance.
The Act was obviously subject to much debate and criticism as the Bill passed through Parliament. It is difficult to properly assess any gaps until after the necessary secondary legislation has been published and comes into force (along with the remainder of the Act), but some of the likely issues include:
- The impact on the insurance market, and the (lack of) availability and increased cost of insurance in light of the provisions of the Act
- How the introduction of retrospective claims will affect the market, both in relation to how parties might go about trying to prove matters which are 30 years old, but also the lack of certainty for those potentially on the receiving end of these claims which they previously had by virtue of the Limitation Act provisions
- Whether the definition of higher risk buildings is correct, or will require some refinement.
The Martlet v Mulalley case provides some useful observations and clarifications, for example that designers cannot necessarily rely on a ‘lemming’ defence that they were simply doing what others were doing at the time, that ‘waking watch’ costs are generally recoverable, and commentary on certain specific Building Regulations. The judgment however made clear that much of the case turned on its specific facts, so it is useful from the perspective of providing some insight as to how the Courts will deal with cladding disputes in future, rather than setting significant precedents to be followed.
The now defunct Guidance for the Tier system suggested that the clinically extremely vulnerable would be treated in the same way as those who were shielding in Lockdown 1. This means that anyone who is clinically extremely vulnerable and cannot work remotely, will be entitled to SSP. These employees should receive a letter confirming that they are deemed to be clinically extremely vulnerable/shielding and you should ask for a copy of it as evidence to support a claim for SSP. It is likely that the Lockdown 3 Guidance will be the same.
You could also furlough an employee in the clinically extremely vulnerable category. Again we do not anticipate this changing.
No. You should always treat employees consistently and fairly, but this doesn’t mean treating them all the same, or applying the same requirements. For those employees who have been homeworking and doing so without any problems, then they should be allowed to continue to do so.
We would anticipate that the vast majority, if not all, businesses will be approaching the return on a phased basis, which inevitably means some employees returning to work sooner than others. In reality then, you aren’t treating everyone the same, but try to be fair and consistent; you need to do what works best from a business perspective, but can you rotate people, require them to come in at different times etc. Where people perceive that the planned return is being worked out fairly they are far more likely to buy into this, which will help avoid resentments building up between colleagues.
The vast majority of disputes settle without ever reaching a final hearing with something in the region of 2-5% of all cases actually ending up in court at a final trial. So whilst it is very unlikely you would need to attend a court hearing, it is always a possibility.