Covid-19 Holiday Accommodation Cover

1982esprit

I am new to this and shall be grateful for any views or comments.  Sorry it is so long but it may also help someone else out who has an NFU Mutual Policy.
Afternoon
I was sorry to learn you will be losing income from your holiday accommodation because of the enforced closure during the Coronovirus outbreak.   Unfortunately I have to advise that Business Interruption does not cover this situation and that NFU Mutual would therefore be unable to assist in this matter.
The situation changes daily and the government may yet advise on measures to assist with lost business for hotels, pubs, restaurants, holiday accommodation, etc.
I am sorry to have to send you this advice.
 
I thank you for your email dated 25th March.
I would like to say that, as a reasonable person, this current unforeseen event is exactly what one would expect to be insured against which is why I have maintained a very comprehensive (and costly) Home and Lifestyle insurance with NFU Mutual who are an extremely reputable company.
On receipt of your email I have re read my policy and schedule and my Holiday accommodation cover protects me for this event under 3 of the clauses together with cover stated in my schedule.  I shall therefore be grateful if you will explain why your advice is that my insurance does not cover this situation.
I look forward to hearing from you and keep safe.

Morning
 I am very sorry that we are unable to assist but the circumstances are unprecedented:  unfortunately you had not chosen the cancellation of advanced bookings extension, this might have covered some immediate refunds you may have had to make  Underneath outlines the stance of NFU Mutual which I hope will clarify the situation.
In line with UK market practice, our standard Business Interruption cover usually requires damage to property in order to be triggered. There is an extension available for human diseases, which provides cover if premises need to close or their use is restricted as a result of a specified list of diseases.
The policy states that we will pay for loss of income, but only caused by the occurrence of any of the diseases listed within the below definition.
Human Diseases
WE will pay for loss of INCOME caused by the occurrence of any of the following diseases at the PREMISES which results in closure or restriction in use of the PREMISES on the order or advice of a competent authority:
Acute Encephalitis Opthalmia Neonatorum
Acute Poliomyelitis Paratyphoid Fever
Anthrax Plague
Cholera Rabies
Diphtheria Rubella
Dysentery Scarlet Fever
Legionellosis Smallpox
Legionnaires’ Disease Tetanus
Leptospirosis Tuberculosis
Malaria Typhoid Fever
Measles Viral Hepatitis
Meningococcal Infection Whooping Cough
Mumps Yellow Fever
COVID-19 is not within the list within the definition of Human Diseases and so this particular loss does not fall within the cover afforded within your policy and unfortunately in this instance we are unable to accept a claim.

NOTE: The above wording has been changed from my policy

I thank you for your prompt reply.

I understand that both Insurers and underwriters have an obligation to make both the policy document and schedule crystal clear to the policyholder at the time of inception.  I entered into a contract with NFU Mutual on the 25th September 2019 at which time this event could not have been foreseen and I accepted my policy and schedule as written.  Following the outbreak of Coronavirus I firmly believed I was covered for this type of emergency as well as others - after all it is both an home and lifestyle policy.
As an ordinary and reasonable person I see that there is a list of human diseases which are expressly covered.  However, nowhere in my policy or schedule does it state that this list is either exhaustive or limited to these diseases.  I cannot believe that if it was the companies intention to limit my insurance to these diseases that it does not say so as it would be very simple to do that.  Further, the policy states that any avian influenza related condition is not insured.  Therefore, if it was the intention to make that list of human diseases exhaustive or limited to there would be no need to specifically exclude any avian influenza related condition.
Further, my schedule specifically covers me for up to £10000 in any one event for food or drink poisoning, infectious diseases or assault.  The definition of schedule states it forms part of my policy.  My policy does not define infectious diseases however I believe there can be no doubt that Covid 19 is an infectious disease.  This, as a reasonable person, further leads me to understand that the list of human diseases is not intended to be exhaustive.
I can only read my policy at face value at the time I took it out and cannot accept express or implied terms or definitions without my agreement thereto after the event as you have appended to in your email.
I appreciate we are all in an emergency situation at present and it may transpire that my cover for infectious diseases will cancel out any proven cover for human diseases.  I shall therefore be grateful if you will open claims under my Holiday accommodation cover at ** and at ** as a matter of urgency as we have had to close these due to both an infectious disease and an human disease.  This is as of the 24th March 2020 being the date I first made contact with yourselves.
I look forward to hearing from you with your instructions on how I proceed.

Thank you for your response.   I will set up a claim, as requested, and advise you the reference and what the next steps will be.

I appreciate NFU are probably quite busy at present which is why I have left it 4 weeks before getting back in touch.
Unfortunately I have had no further communication at all from NFU in this time.  I shall be grateful if you will provide me with the contact details of my claims handler in order that I may liaise directly and start progressing this matter.
I thank you for your assistance and look forward to hearing from you.

Sorry about this – I will chivvy up the handler and make sure you are contacted

I find myself having to write again in anger and disgust with the way in which NFU Mutual are treating me with contempt regarding my claim for loss of income under my insurance policy.
I first raised my claim on 24th March 2020 which was immediately declined with no explanation.  Following my requests for reasoning there was an attempt to deceive me by NFU Mutual in that I was emailed copy policy documentation whereby the wording had been changed from my policy documentation.  Following further correspondence my claim was approved and set up on the 30th March.
Having waited patiently I received a telephone call from ** on Sunday 2nd May 2020 advising me she had good news in that my claim had been authorised.  She asked to submit my income for the periods 23/03/18 and 2019 to 29/05/18 and 2019 which I duly did.  On the 18th May 2020 I received a courtesy call from ** apologising for the delay and advised she was awaiting authorisation for payment.  Having not heard further I telephoned ** yesterday (09/06/20) and she advised me my claim had not been authorised on the basis of Government assistance.
Firstly, whether or not I have received Government assistance is none of your business and bears no correlation to my insurance policy.
Secondly, I have previously stated that I cannot accept express or implied changes to the terms of my policy after the date of inception and nowhere in my policy or schedule  does it state that Government assistance forms part of the excess.
Thirdly, our Chancellor, Rishi Sunak, informed the British public on 17th March 2020 that Government measures will have no impact on businesses making an insurance claim against their policy.
I really do not know what NFU Mutual are playing at - I have obviously been under the illusion for nearly 6 claim free years now that NFU Mutual are better than this.  In fact over this period I have paid out £** in premiums to yourselves only to find that when I actually do need to make a claim you are contradicting your own policy and telling me it is useless!
Further, I really am bemused by what you are reading and where you are drawing your conclusions from.  THIS IS A SIMPLE CONTRACTUAL MATTER WRITTEN IN BLACK AND WHITE.  MY SCHEDULE STATES I AM COVERED UP TO £10000 PER PROPERTY FOR "FOOD OR DRINK POISONING, INFECTIOUS DISEASES OR ASSAULT". My policy does not define any of the aforementioned and you have already agreed Covid-19 is an infectious disease.  I understand I am liable for the voluntary excess or £100 per property as stated in my schedule.  I have honoured my end of the bargain - please now honour yours.
Due to the manner in which I have been treated I expect and ask you to confirm your position by close of business on Friday 12th June 2020.  If I have not heard by then or my claim is refused I will have no alternative but to issue a letter before action on Monday 15th June 2020 and seek recourse through the Courts.
I also request the reader of this email to forward a copy to the Directors of NFU Mutual as I as a customer am unable to contact any of them directly.

Please see a draft template below. There is one section in red you will need to pad out with the insured’s circumstances 😊
Main Body:
I write today with reference to the claim you have submitted under the loss of profit section of your policy for your holiday accommodation.
Under the loss of profit section of your policy, your holiday accommodation is insured against interruption due to:
food or drink poisoning, or any HUMAN
DISEASE if it must be reported to the local
authority. The illness or disease may be:
- at YOUR HOLIDAY HOME;
- within 25 miles of YOUR HOLIDAY HOME;
or
- traced back to food or drink supplied from
YOUR HOLIDAY HOME;
 The policy definition for HUMAN DISEASES does not include COVID19, so ordinarily there would be no cover the policy can offer. However, there is a discrepancy in the holiday accommodation section of the cover summary which states ‘Infectious diseases’. Due to the ambiguity, and the fact the wording is not clear we are honouring the claims for COVID19 under this section whilst the government restrictions are in place.
As this is a loss of profit cover, when validating the claim and calculating the loss we will take into consideration income received to establish what the loss of profit value is and what can be paid as part of a successful claim. Income can include, and is not restricted to, deposits retained, refunds received from booking agents and financial support schemes such as grants.
(Insert section regarding his claim- value of loss/grant and why we are unable to consider at this stage)
I regret that I cannot write more favourably at this time, but trust the above explains our stance. Should you have any additional queries please do not hesitate in getting in contact.

 

I have just sent the email below to ** and received an automated reply stating he is out of the office until 15th June.  I am not able to wait until then for a response.

I shall be grateful if you will forward this to your board of directors as a matter of urgency.
I thank you for your assistance

Firstly I put it in writing that your colleague, **, is a down to earth honest and professional employee. She has treated me with respect at this awful time of concern and uncertainty. She has done everything in her power to keep me updated in progressing this matter. I will relay this to her personally in a separate email.
You sir are a disgrace to yourself, your company and its customers. HOW VERY DARE YOU SIT THERE BEING SO CONTEMPTUOUS IN EMPLOYMENT EARNING YOUR SALARY WHILST TREATING ME LOWER THAN A PIECE OF S**T ON THE SOLE OF YOUR SHOE.  Let me explain to you why I have allowed my usual professional standard to slip and why you have made me so bloody angry during this time of serious worry and concern for the welfare of myself, my family and the stark reality of losing our business.
1    24th March 2020 - I submitted a claim under my policy
2    30th March 2020 - My claim is approved and I am issued with a claim reference
3    2nd May 2020 - I receive a telephone call from ** who is delighted to inform me my claim has been approved for loss of income up to the limit of £20000 less the £200 total voluntary excess.  She asks me to submit proof of our income for a set period from the previous 2 years.
4    5th May 2020 - I submit proof of our income for the required period.
5    18th May 2020 - I receive a courtesy telephone call from ** advising she is awaiting authorisation to pay the first part of my claim.
6    9th June 2020 - I telephone ** for an update to be told my claim cannot be authorised.
I have sat here since the 2nd May 2020 believing I will be receiving a payment from NFU Mutual in settlement of the first part of my claim.
7    10th June 2020 - I write an email to NFU Mutual setting out and explaining my position as opposed to merely taking a stance without due regard for the facts in this matter.
You on the other hand have done nothing to expedite my claim, nothing to keep me properly informed or updated, do not even show a basic level of understanding of contract law and quite frankly have fobbed me off and left me under the false illusion that my life will be ok in this crisis as I have been diligent enough to pay for a comprehensive insurance policy with an allegedly reputable company.
Further, you are now very late in the day telling me that, in your opinion, I have an ambiguous contract with yourselves that contains discrepancies.  NFU Mutual not only have massive resources at their disposal to ensure policies and schedules are properly written but they are also governed and have to comply with legislation.  Are you actually telling me that I have paid out £** to NFU Mutual for the past 6 years for ambiguous policies that contain discrepancies because I could really do with that wasted money back in my bank account right now.
The icing on the cake is that you can sit there knowing your life is fine and dandy whilst asking a colleague to pad out my circumstances in an attempt to avoid and delay your responsibilities pursuant to our contract.  You then have the contemptuous cheek to put a cherry on top of the cake by adding a smiley face because, believe me, there are no smiling faces in my household.  I can only imagine how pleased NFU Mutual would be if they could refuse my claim because I padded it out and added a smiley face to it.
In all my communications regarding this matter I have conducted myself in a professional, respectful and courteous manner albeit I have fought my corner in a strong vein when necessary.  I have thought about using my contacts on social media to assist me.  I have thought about contacting the news in the hope I may receive assistance in this matter.  I would like to refer this matter to the Financial Ombudsman but due to the current crisis they are under enormous strain and time is not on my side.  I was going to seek settlement of this matter in the County Court but am now looking at my options of taking an High Court action as I will be seeking compensation for the mis selling of an insurance product over the period of 6 years.
I now demand you refer this email to your board of directors who not only may have a basic understanding of contract law but will treat a loyal customer with respect.  We may also be able to resolve this matter expediently in a professional and civil manner without the aforementioned action becoming necessary and trust I will hear by close of business tomorrow.

davidmcn

Please summarise your query (if you have one), nobody's going to read through all this.

1982esprit

My apologies again - my 2 main queries are

Does the receipt of a small business grant count towards income when calculating loss of profit for the purpose of an insurance claim?

Does the claim end when restrictions are lifted on holiday accommodation or when all restrictions are lifted or when trade returns to normal based on previous years?

Thank you for taking the time to look

paddyandstumpy

1982esprit said:

My apologies again - my 2 main queries are

[1] Does the receipt of a small business grant count towards income when calculating loss of profit for the purpose of an insurance claim?

[2] Does the claim end when restrictions are lifted on holiday accommodation or when all restrictions are lifted or when trade returns to normal based on previous years?

Thank you for taking the time to look

Neither of those queries are listed in that wall of text above! 

You were doing so well, until you started swearing and 'shouting' at the insurer. 

Normally for BI claims to respond, there has to be damage/incidence at the insured address. That said, NFU appear to have agreed cover on the basis their wording is ambiguous. This is good, you should be praising them for this. 

There is a High Court case ongoing (and I'm sure NFU are one of the defendants), testing insurer wordings and coverage given the current pandemic. Most insurers (if the wording is ambiguous) are now holding settlements pending outcome of this case. 

Anyone's personal views in the mean time are irrelevant. 

Was your sale on an advised basis? Your paperwork will tel you this. If it wasn't advised, there is no 'mis-selling'. Additionally, unless they told you that you would be covered for a global pandemic and the enforced closure of your business as a result, there there is no 'mis-selling'. 

Now, to answer your queries: 
[1] Yes, it should. The purpose of insurance in this instance is to indemnify you for lost profit as a result of the insured peril. In this case, if you are in receipt of Govt funding, this will have gone some way to recompense your lost income for this pandemic period. 

Therefore, your lost profit is what you are 'missing' when you take the Govt grant into consideration. 

[2] as they appear to have agreed settlement of your claim on an ex gratia basis, only the insurer can answer this. 

1982esprit

paddyandstumpy said:

1982esprit said:

My apologies again - my 2 main queries are

[1] Does the receipt of a small business grant count towards income when calculating loss of profit for the purpose of an insurance claim?

[2] Does the claim end when restrictions are lifted on holiday accommodation or when all restrictions are lifted or when trade returns to normal based on previous years?

Thank you for taking the time to look

Neither of those queries are listed in that wall of text above! 

You were doing so well, until you started swearing and 'shouting' at the insurer. 

Normally for BI claims to respond, there has to be damage/incidence at the insured address. That said, NFU appear to have agreed cover on the basis their wording is ambiguous. This is good, you should be praising them for this. 

There is a High Court case ongoing (and I'm sure NFU are one of the defendants), testing insurer wordings and coverage given the current pandemic. Most insurers (if the wording is ambiguous) are now holding settlements pending outcome of this case. 

Anyone's personal views in the mean time are irrelevant. 

Was your sale on an advised basis? Your paperwork will tel you this. If it wasn't advised, there is no 'mis-selling'. Additionally, unless they told you that you would be covered for a global pandemic and the enforced closure of your business as a result, there there is no 'mis-selling'. 

Now, to answer your queries: 
[1] Yes, it should. The purpose of insurance in this instance is to indemnify you for lost profit as a result of the insured peril. In this case, if you are in receipt of Govt funding, this will have gone some way to recompense your lost income for this pandemic period. 

Therefore, your lost profit is what you are 'missing' when you take the Govt grant into consideration. 

[2] as they appear to have agreed settlement of your claim on an ex gratia basis, only the insurer can answer this. 

Thank you very much for the above - yes I have allowed emotion to intervene.  I have sent an apology to NFU staff concerned and copy it below as I crossed a line and was wrong to do so

I write as a formal apology to you for allowing my personal circumstances in this crisis with which we are all faced to influence my use of offensive language and personal reference in the email I sent to you on 11th June 2020.
I will remove it from any threads of communication between NFU Mutual and myself.  I will write a more dignified reply direct to **  early next week and copy you in.
My apology is extended and copied to all NFU Mutual staff to whom I re sent the email as I do now, whatever the outcome, you are all just doing your jobs.
My sincere apologies