What routes of challenge are available to an insurer’s rejection of my business interruption claim?

The Coronavirus Statutory Sick Pay Rebate Scheme will repay employers the SSP paid to current or former employees and will be available from 26 May 2020. See here.

The scheme covers all types of employment contracts and employers will be eligible to claim if they:

• Are claiming for an employee who is eligible for sick pay due to coronavirus
• Had a payroll scheme that was created and started on or before 28 February 2020
• Had fewer than 250 employees on 28 February 2020

The repayment will cover up to 2 weeks starting from the first qualifying day of sickness, if an employee is unable to work because they either:

• have coronavirus (COVID-19) symptoms
• cannot work because they are self-isolating because someone they live with has symptoms
• are shielding and have a letter from the NHS or a GP telling them to stay at home for at least 12 weeks
• have been notified by the NHS or public health bodies that they’ve come into contact with someone with coronavirus
• they have been notified by the NHS to self-isolate before surgery

You can claim for periods of sickness starting on or after:

• 13 March 2020 – if your employee had coronavirus or the symptoms or is self-isolating because someone they live with has symptoms; or
• 16 April 2020 – if your employee was shielding because of coronavirus.
• 28 May 2020 – if your employee has been notified by the NHS or public health bodies that they’ve come into contact with someone with coronavirus
• 26 August 2020 – if your employee has been notified by the NHS to self-isolate before surgery

Employees do not have to give you a doctor’s fit note for you to make a claim. But you can ask them to give you either:

• an isolation note from NHS 111 – if they are self-isolating and cannot work because of coronavirus
• the NHS or GP letter telling them to stay at home for at least 12 weeks because they’re at high risk of severe illness from coronavirus
• the evidence from the NHS or public health body requiring them to self-isolate

You must keep the following records in relation to a claim you make under the scheme for three years:

• The reason for the employee’s absence
• Details of each period the employee could not work, including start and end dates
• Details of the SSP qualifying days when the employee could not work
• National insurance numbers for each employee you have paid SSP to

You’ll need to print or save your state aid declaration (from your claim summary) and keep this until 31 December 2024.

• Delays in preparing and submitting applications to comply with pre-commencement conditions. In this respect there can be lengthy timescales gathering evidence to support applications to comply with pre-commencement conditions, ecology, contamination and archaeology are examples of matters which can require significant periods of survey work
• Following on from the above the ability to get required experts on the site necessary to undertake the required survey work
• Delays in the determination of applications to comply with pre-commencement conditions. In this respect whilst there are deemed discharge provisions/procedures concerning certain matters, the provisions cannot be used to discharge all types of conditions
• The ability to get people on site to undertake material operations

In the circumstances, it is advisable to start considering the implementation of the planning permission early and the earlier the better. Under current legislation whilst it is possible to vary conditions, albeit potentially leading to wider issues, it is not possible to extend the life of a planning permission meaning that lawful implementation is essential to avoid the loss of that permission.

If a planning permission is lost, amongst other things it may not be granted again or may not be granted on similar terms. In the circumstances, it is advisable to seek advice given the specific facts of the case to minimise the risk of a planning permission not being lawfully implemented and expiring.

You cannot include the following payments in a claim:

• Discretionary bonus or commission payments
• Tips
• Non-cash payments
• Non-monetary benefits including taxable benefits in kind
• Salary sacrifice benefits that reduce an employee’s pay (however HMRC has agreed that such arrangements can be stopped by agreement if due to COVID-19 and the contract is changed)

The updated guidance has confirmed that all of the grant claimed should be paid to the employee in the form of money and that none of the grant is to the used to pay for the provision of benefits or a salary sacrifice scheme.

A number of our clients and networks raised issues in the early stages of the Scheme around the requirement for personal guarantees to access finance under the Scheme. The Scheme has now been updated so that:

• For facilities under £250,000, personal guarantees cannot be taken to support lending under the Scheme.
• For facilities above £250,000, personal guarantees may still be required by a lender but the amount which can be recovered under these guarantees is capped at a maximum of 20% of the outstanding balance of the CBILS facility after taking into account any other recoveries from business assets.

There is no simple answer.

The NFCC guidance states:

“The person-centred fire risk assessment is intended only as a simple means for non-specialists who have suitable understanding of relevant fire risks to determine whether additional fire precautions might be needed. The person who carries out the person-centred fire risk assessment will depend on the circumstances of the housing and support provision. It can be carried out by those who regularly engage with the resident, with input from specialists where necessary. Assessments will normally be undertaken with residents themselves.

In sheltered housing with scheme managers, the scheme managers normally engage with residents on a routine basis, enabling residents who need a person-centred fire risk assessment to be identified. Many vulnerable residents will be in receipt of care, so enabling the care provider to identify residents in need of a person-centred fire risk assessment. Providers of regulated care are required to take into account risks to people from their wider environment, to take steps to help people ensure that they are dealt with by appropriate agencies, or to raise safeguarding alerts when this is appropriate. Where a ‘stay put’ strategy is adopted, there will be a need to identify residents who need assistance from the fire and rescue service to evacuate the building.

In supported housing, the number of residents in each property is usually quite small. This, and the nature of the care service normally provided, enables person-centred fire risk assessments to be carried out asa matter of course, when a resident first moves into the property.

Where additional fire precautions cannot be provided in the short term, the risk should be reduced as far as reasonably practicable and an adult at risk referral should be made to Adult Social Care.”

Ideally then the RP will need to engage with any care providers in order to conduct the PCRA and identify risk mitigation measures. If they are reluctant to do so, the RP should engage with the individual in any event in undertaking the assessment.