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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

How do I apply for CBILS?

CBILS is made available through the British Business Bank’s 40+ accredited lenders and partners, which are listed on their website (https://www.british-business-bank.co.uk/ourpartners/coronavirus-business-interruption-loan-scheme-cbils/accredited-lenders/).  

 Businesses should initially approach their own lender and only consider other lenders if they are unable to access the finance they need. Note, not every accredited lender can provide every type of finance listed.   

 Some banks/lenders are not included in the list of accredited lenders which appears to mean that they cannot provide support through the Scheme. We understand from the British Business Bank that further lenders are applying to be accredited but that this may take a little time to process. If the provider of your senior debt is not on the accredited list you should consider approaching the bank which provides your day to day account banking services.

 If you wish or need to access the Scheme via an alternative funder the process may take longer as usual on-boarding and KYC processes will need to be undertaken.  

What should I be mindful of in relation to pregnant workers? Is there a right to suspend?

Yes, but as a last resort. In summary, the law requires employers:

  • to assess the workplace risks posed to new or expectant mothers or their babies;
  • to alter the employee’s working conditions or hours of work to avoid any significant risk to them;
  • where it is not reasonable to alter working conditions or hours, or would not avoid the risk, to offer suitable alternative work on terms that are not “substantially less favourable”;
  • where suitable alternative work is not available, or the employee reasonably refuses it, the employer should consider whether it is appropriate to suspend the employee on full pay.
How do I implement temporary contractual arrangements?

The Government expects the use of bespoke contractual documents to implement temporary arrangements relating to your PFI contracts.

With time and resource precious commodities, focus should be given to documenting:

  • The key changes to your PFI requirements
  • The temporary nature of the measures
  • The requirement for best efforts on behalf of the PFI Contractor
  • The importance of continued health and safety measures at all times
What amount do you claim under the Flexible Furlough Scheme?

You will claim a pro rata’d amount of 80% of salary, based on the proportion of hours not worked out of the employee’s normal working hours (their “usual” hours).

There are 2 ways to calculate an employee’s usual hours, depending on whether they have fixed or variable hours/pay:

  • For those with fixed hours/pay, you take the number of hours worked in the pay period before 19 March 2020.
  • For those with variable hours/pay, you take the higher of:
  1. the average number of hours worked in the tax year 2019 to 2020 or
  2. the corresponding calendar period in the tax year 2019 to 2020.

If employees are paid per task or piece of work done, you should work out the usual hours for these employees in the same way as for other employees who work variable hours, if possible.

When you calculate the usual hours, you should include any hours of leave for which they were paid their full contracted rate (such as annual leave) and any hours worked as overtime (but only if the pay for those hours was not discretionary).

How much will I get under the scheme?

If you are eligible you will get a taxable grant of 80% of the average profits from the following tax years (where applicable):

2016-2017

2017-2018

2018-2019

HMRC will add the total profit in each of the three tax years (if applicable). This will then determine the monthly payment, subject to the cap of £2500.