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UK businesses win right to COVID business interruption insurance payouts: Are you eligible to claim?

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The UK’s Supreme Court has ruled that hundreds of thousands of UK businesses that attempted to claim for coronavirus-related business interruption losses will receive insurance payouts. The court’s decision follows the Financial Conduct Authority’s appeal on behalf of policyholders. However, the case has brought to light other policy loopholes that need to be addressed.

Many policyholders whose businesses were affected by the COVID pandemic suffered significant losses, resulting in large numbers of claims under business interruption (BI) policies.

While most SME policies are focused on property damage and only have basic cover for BI as a consequence of property damage, some policies also cover BI from other causes, including infectious or notifiable diseases (‘disease clauses’) and prevention of access and public authority closures or restrictions (‘prevention of access clauses’).

In some cases, insurers have accepted liability under these policies.  In other cases, insurers have disputed liability while policyholders considered that they had cover leading to widespread concern about the lack of clarity and certainty. 

Insurers relied heavily on a previous judgment from 2010 called ‘Orient Express’ in their submissions on causation, according to the FCA.

“The Supreme Court has ruled that the case was wrongly decided. This has wider implications beyond the pandemic that BI policies are more likely to respond to other types of ‘wide-area damage’ such as storms or floods,” said the FCA.

“Coronavirus is causing substantial loss and distress to businesses and many are under immense financial strain to stay afloat. This test case involved complex legal issues. Our aim throughout this test case has been to get clarity for as wide a range of parties as possible, as quickly as possible, and today’s judgment decisively removes many of the roadblocks to claims by policyholders,” said Sheldon Mills, Executive Director, Consumers and Competition at the FCA.

Mills said in a statement that the FCA will be working with insurers to ensure that they now move quickly to pay claims that the judgment says should be paid, making interim payments wherever possible. 

“Insurers should also communicate directly and quickly with policyholders who have made claims affected by the judgment to explain next steps,” said Mills.

Sheldon Mills was appointed Executive Director, Consumers and Competition in December 2020. He was previously the Interim Executive Director of Strategy and Competition at the FCA. Mills and the FCA will be working with insurers to ensure that they now move quickly to pay claims.

The legal case

The FCA did its homework. The watchdog selected a representative sample of 21 types of policy issued by eight insurers. The FCA then argued for policyholders that the ‘disease’ and ‘prevention of access’ clauses in the representative sample of 21 policy types provide cover in the circumstances of the coronavirus  (Covid-19)  pandemic and that the trigger for cover caused policyholders’ losses. In the end, 370,000 policyholders were identified as holding 700 types of policies issued by 60 insurers that may be affected by the outcome of the test case.   

The High Court’s judgment last September resolved most of the key issues. However, the FCA and insurers were unable to reach an agreement, so they ‘leapfrogged appeals to the Supreme Court (without going to the Court of Appeal first). 

On the FCA’s appeal, the Supreme Court ruled that cover may be available for partial closure of premises (as well as full closure) and for mandatory closure orders that were not legally binding; that valid claims should not be reduced because the loss would have resulted in any event from the pandemic; and that two additional policy types from insurer QBE provide cover. This will mean that more policyholders will have valid claims and some pay-outs will be higher.     

What’s next for affected policyholders?

The judgment brings to an end legal arguments under 14 types of policy issued by six insurers, and a substantial number of similar policies in the wider market which will now lead to claims being successful. 

The FCA’s decision to bring the test case has removed the need for policyholders to resolve many key issues individually with their insurers.  It enabled them to benefit from the expert legal team assembled by the FCA, providing a comparatively quick and cost-effective solution to the legal uncertainty in the business interruption insurance market.

The test case was not intended to encompass all possible disputes, but to resolve some key contractual uncertainties and ‘causation’ issues to provide clarity for policyholders and insurers. Today’s judgment does not determine how much is payable under individual policies but provides much of the basis for doing so.

Following the High Court’s judgment, insurers decided to pay claims on some policies and the FCA asked insurers to progress claims on other policies that the High Court said provided cover so that they could be settled quickly following the appeals to the Supreme Court. 

The watchdog will now work with insurers so that they rapidly conclude their claims processes on claims that the Supreme Court has said should be paid, providing interim payments wherever possible.   

Each policy needs to be considered against the detailed judgment to work out what it means for that policy. Policyholders with affected claims can expect to hear from their insurer soon. Policyholders with questions should approach their broker, other advisers or insurer.  Policyholders who remain unhappy following their insurer’s assessment of their claim may be able to refer their claim to the Financial Ombudsman Service, whose role is to resolve individual disputes.

The FCA’s legal team at Herbert Smith Freehills has published a bulletin on their website.

Next steps

The FCA will publish a set of Q&As for policyholders to assist them and their advisers in understanding the test case. The FCA will also publish a list of BI policy types that potentially respond to the pandemic based on data that we will be gathering from insurers.

The FCA has published draft guidance for policyholders on how to prove the presence of coronavirus, which is a condition in certain types of policy. The consultation closes on 18 January, but the FCA is extending the closing date to 22 January only for any supplemental comments arising from the judgment. The FCA will issue finalised guidance as soon as possible after that. 

The FCA will keep policyholders updated as they progress, through its dedicated webpage.

The judgment is available on the Supreme Court’s website.

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