“the amount by which the Gross Revenue during the Indemnity Period shall fall short of the Standard Gross Revenue in consequence of the Damage”
“Insurance Policy: Property Owners Effective Date:24/09/2022 Your insurance policy is due for renewal shortly and we have pleasure in enclosing your renewal quotation(s) and documentation. These have been based on your requirements which he disclosed to us previously or in our recent renewal discussions. Our understanding of your requirements are shown in the enclosed documentation. There are a number of documents enclosed and it is important that you review each of them. Within this letter we have summarised what we consider to be the most important points to assist you. We direct you to those documents, or parts of documents, which you must read carefully. Your renewal premium(s) for the forthcoming year are detailed as below: Policy: Property owners Premium:£1,550.00 Insurance Premium Tax£186.00 Administration Fee(s)£60 Total due:£1,796.00 Property Owners Your Requirements and Our Recommendations We draw your attention to your Duty of Fair Presentation obligations, along with the importance of checking that you have adequate sums insured. Full details can be found in the Important Information section. … Significant Terms, Conditions, Warranties, Exclusions and Subjectivities Your policy documents will record what is insured and against what Insured Perils … It is important that you read and make sure that you understand the full extent of the cover that is provided by your insurance policy. The policy wording should be read in conjunction with your policy schedule. Whilst you must review all of your documentation, outlined below are any significant terms …. Policy Documents It is important that you check through your policy documentation. Please read all documents carefully, paying particular attention to the limits, endorsements and exclusions. If any information is incorrect, please contact us immediately. … If you have any questions relating to insurance arrangements, please do not hesitate to contact us. We look forward to receiving your renewal confirmation by the renewal date. Failure to provide your instructions could result in your policy and cover lapsing. … Enclosures Policy Schedule(s) Please review and advise us immediately if there are any terms you are unable to comply with or do not understand. Policy Summary(s) An overview of the proposed cover including limits. Please read in conjunction with your policy and advise us immediately if there are any terms you are unable to comply with or do not understand. Our Invoice Please note payment terms. Important Information Please read and retain. Important Information Please read this section carefully as it contains important terms and may require you to take action. 1. Sums Insured and Under-Insurance (average) Ensure that you are insured for the full value of risk in accordance with the policy terms and conditions. We strongly recommend that you obtain professional valuations for reinstatement purposes of buildings, machinery and plants at regular intervals. Sums insured and limits of indemnity should be kept under review throughout the period of insurance. It is important that you are NOT underinsured. Make sure you have insured your buildings for the full rebuilding cost including allowances for architects’ costs and site clearance, and your contents for their full replacement value as new items. You must notify us if the full replacement value of your contents or full rebuilding cost of your buildings exceeds the amount shown on your schedule. The insurer will only be able to settle claims that the percentage you are actually insured for. For example, if the value of your content shown on your schedule only represents 70% of the full replacement value then the insurer will not pay more than 70% of your claim.”
“Can it be reduced to£1500 ?”
“Given the property being unoccupied there is no way insurers will reduce their premium I’m afraid. Most insurers either won’t insure this or want at least£2500 with far more restricted cover. I can remove our admin fee of£60 , which takes it to£1550.00 + insurance premium tax£186.00 =£1736.00 .”
“Of: “As such, [the Policy] provided cover in respect of the loss of Gross Revenue due to Business Interruption … Requests: 12. What Gross Revenue does the Defendant allege it earned from its business at [the Property] between the date the Policy incepted and the date on which the Water Damage occurred? Response: 12: None. … the fact that the business was not generating Gross Revenue in this period is no answer to the claim for loss of Gross Revenue which would have been earned at [the Property] but for the interruption caused by the Water Damage.”
“As discussed this morning, I am glad you were aware that the [Property] was unoccupied and we were not yet operational when the [Policy] started. … shall I update Katie Miller the claim handler or is she already aware of this?”
“INTRODUCTION … This Policy (and Schedule which forms an integral part of the Policy) is a legal contract. … The Schedule attached to this policy provides details of the Sections that are operative and the cover that has been agreed. … We will provide the insurance described in this Policy subject to its Terms and Conditions for the Period of Insurance shown in the Schedule and any subsequent period for which you shall pay and we shall agree to accept the premium. … TABLE OF CONTENTS … Policy Conditions Policy Exclusions General Policy Definitions Section A: Property Damage Insurance and Business Interruption Insurance … POLICY CONDITIONS … 4. CHANGE IN CIRCUMSTANCES As a condition precedent to Our liability under this Policy, You must notify us in writing as soon as possible of any changes or alterations in your Business or the Premises, Property insured or any other subject matter insured under this Policy (a) Examples of changes notifiable pursuant to this condition include but are not limited to: … (iv) changes to the type of work, processes or goods manufactured / sold by Your Business; … (vi) an increase in the amount and level of work away from the Premises; (vii) a change in the turnover, number of people employed and wages paid … (b) Following any such changes, depending on the assessment of materiality, We may in Our absolute discretion: (i) agree for cover under this Policy to continue to apply on the same terms notwithstanding the notified change or alteration; (ii) amend the Policy to record the correct information; (iii) restrict the cover provided under this Policy; (iv) impose additional terms; (v) alter the Premium; (vi) cancel the Policy There will be no cover for any claims under this Policy if notice is not given as required by this condition and there will be no cover provided following the giving of notice unless and until We agree for cover under this Policy to continue to apply on the same or amended terms. … General Policy Definitions The following words or expressions shall have the meanings set out below for the whole of the Policy unless a more specific definition applies in an individual section. Business The business description of the Policyholder as stated in the Schedule Damage Accidental loss, destruction or damage Increased Cost of Working Means the additional expenditure necessarily and reasonably incurred for the sole purpose of avoiding or diminishing the Loss of Gross Revenue which but for that expenditure would have taken place during the Indemnity Period in consequence of the Damage Limit of Indemnity The amount stated in the Policy and/or Schedule as being the maximum amount of the Insurer’s liability in respect of any Event … Period of Insurance The period of time that the Policy is in force as shown in the Schedule Premises The premises owned, occupied, leased or rented by the Policyholder as stated in the Schedule Premium The monetary amount paid or payable by the Policyholder for coverage under the Policy Property The material assets owned by the Policyholder … Schedule The statement of details specific to the Policyholder, forming part of the Policy Sum Insured The sum stated in the Schedule, which corresponds with the relevant section. SECTION A: PROPERTY DAMAGE INSURANCE AND BUSINESS INTERRUPTION INSURANCE This insurance does not apply if shown as not insured in the Schedule. 1. GENERAL INSURING CLAUSE If any of the Property Insured described in the Schedule suffers Damage by any of the covers insured during the Period of Insurance, the Insurer will in accordance with the provisions of the Policy pay to the Policyholder: 1.1 In respect of property damage insurance, the amount of loss or at the Insurer's option reinstate, repair or replace such property provided that the Insurer's liability in any one Period of Insurance shall not exceed in the whole the total Sum Insured or in respect of any item its Sum Insured or any other stated limit of liability. 1.2 In respect of business interruption insurance, the amount of loss resulting from the interruption or interference with the Policyholder’s Business at the Premises caused by the Damage to the Property, provided that: (a) the Insurer’s liability in any one Period of Insurance shall not exceed in the whole the total Sum Insured or in respect of any item its Sum Insured or any other stated limit of liability; (b) payment has been made or liability admitted by Insurers for the Damage under a Policy Covering the Interest of the Policyholder in the Property, all payments would have been made or liability admitted for the Damage but for the operation of a proviso in such Policy excluding liability for losses below a specified amount. 2. PROPERTY DAMAGE AND BUSINESS INTERRUPTION COVERS The following are the covers insured unless stated as covers not insured in the Schedule. […] 2.5 Escape of water or oil from any tank, apparatus or pipe excluding Damage: - by water discharged or leaking from an automatic sprinkler installation; or - in respect of any Building which is empty or not in use.”
“BUSINESS INTERRUPTION INSURING CLAUSES Calculated on the basis of Gross Revenue (unless shown as not insured in the Schedule). Subject to the special provisions below the Insurer will pay as indemnity: 9.1 in respect of Loss of Gross Revenue: the amount by which the Gross Revenue during the Indemnity Period shall fall short of the Standard Gross Revenue which would have been obtained during the Indemnity Period, if the Damage had not occurred and allowing for trends of the Business or circumstances which would have affected the Business irrespective of the Damage occurring in consequence of the Damage; 9.2 in respect of Increased Cost of Working: the additional expenditure necessarily and reasonably incurred for the sole purpose of avoiding or diminishing the Loss of Gross Revenue which but for that expenditure would have taken place during the Indemnity period in consequence of the Damage: but not exceeding the total of: • The amount of the reduction in Gross Revenue thereby avoided; plus • 5% of the Sum Insured by the item (but not more than£250,000 ). Calculated on the basis of Gross Revenue (unless shown as not insured in the Schedule). Subject to the special provisions below the Insurer will pay as indemnity: 9.1 in respect of Loss of Gross Revenue: the amount by which the Gross Revenue during the Indemnity Period shall fall short of the Standard Gross Revenue which would have been obtained during the Indemnity Period, if the Damage had not occurred and allowing for trends of the Business or circumstances which would have affected the Business irrespective of the Damage occurring in consequence of the Damage; 9.2 in respect of Increased Cost of Working: the additional expenditure necessarily and reasonably incurred for the sole purpose of avoiding or diminishing the Loss of Gross Revenue which but for that expenditure would have taken place during the Indemnity period in consequence of the Damage: but not exceeding the total of: • The amount of the reduction in Gross Revenue thereby avoided; plus • 5% of the Sum Insured by the item (but not more than£250,000 ). 10. UNDERINSURANCE IN RESPECT OF BUSINESS INTERRUPTION If at the time of the Damage the Sum Insured is less than the Insurable Amount the amount otherwise payable shall be proportionately reduced. 11. SPECIAL PROVISIONS … 11.2 Alternative Trading If during the Indemnity Period services are rendered other that at the Premises, for the benefit of the Business, either by the Policyholder or by others on the Policyholder’s behalf, the money paid or payable in respect of such sales or services shall be taken into account in arriving at the Gross Revenue during the Indemnity Period. … 11.5 Savings If any of the charges or expenses of the Business payable out of Gross Revenue cease or reduce in consequence of the Damage the amount of such savings during the Indemnity Period shall be deducted form the amount payable.”
“The court may give summary judgement against the claimant or defendant on the whole of the claim or an issue if- (a) it considers that the party has no real prospect of succeeding on the claim, defence or issue; and (b) there is no other compelling reason why the case or issue should be disposed after trial.” (a) it considers that the party has no real prospect of succeeding on the claim, defence or issue; and (b) there is no other compelling reason why the case or issue should be disposed after trial.”
“… UK Business interruption insurance is based on a loss of turnover. That is true in the sense that turnover is the starting point for the calculation of loss for both gross profit and gross revenue policies. A gross profit policy then deducts costs (generally known as the uninsured specified working expenses) that a policyholder assumed would vary directly in line with any reduction in turnover, before adding increased costs incurred to mitigate loss and finally reducing the adjusted loss to reflect any actual reduction in other costs (that is other than those already deducted to calculate gross profit). A gross revenue policy streamlines that process by simply deducting the actual reduction in any costs that occurs …”
“Experience has shown that the proportionate effects for fire (for example) upon the earning capacity of a business can be readily and accurately measured, in most cases, by comparing the turnover in the months following the damage with that in the corresponding period, in the 12 months preceding it, subject to appropriate adjustments for special circumstances or trends of business. For example, if a fire causes interruption of business throughout October, November and December, the loss of turnover during those months can be found by means of a comparison with the turnover for October, November and December in the preceding year. In general, the loss of turnover during any other period of whatever length can be used as a yardstick for measuring the interruption of trading, subject provision being made for any necessary adjustments.”
“3.13 Another form of dependency risk relates to investment in new projects, be they infrastructure, new production plants, or extensions to existing facilities. If these projects are delayed, then the anticipated revenue stream is likely to be affected. This is termed advanced loss of profits or delay in startup. The term advanced loss of profits (ALOP) tends to be used in relation to established businesses that are expanding their capacity at existing locations, whereas delay in start up (DSU) is the term more commonly used when dealing with new projects such as infrastructure (e.g. a new airport) or a major production facility (ego an oil refinery). A delay in completion of such a project is another risk that a business may face, yet the standard business interruption cover would be unlikely to engage because the building, plant or machinery may not be at the premises, and will not yet have been used by the insured for the purpose of the business. Unlike the other dependency risks discussed earlier in this chapter, separate cover will be required as opposed to an extension to an existing business interruption policy … 3.14 … [DSU] cover is triggered at the points an incident occurs that is likely to delay the project beyond the date that it would otherwise have commenced commercial operation, but for the action of the insured peril. 3.15 … Unlike standard business interruption cover, the indemnity period under an ALOP or DSU policy does not commence with the date of an incident triggering the material damage cover. Instead the indemnity period will commence at a date in the future when revenues would otherwise have commenced … Reduction of turnover during the Indemnity Period is used as the index by which the loss is to be measured but because the facility will not have been in operation, or at any rate not at full output (otherwise the claim cannot arise), it has to be a reduction in anticipated turnover. The rate of gross profit is that “which but for the Incident would have been and on the turnover during the Indemnity Period.”
“18-001 Delay in start up insurance (“DSU”), often taking the form of advanced loss of profit insurance (“ALOP”), provides cover for financial losses (i.e. loss of profit) caused by delay to the completion of the construction … project as a result of physical damage. Other forms of DSU are “loss of revenue”, “fixed costs only” or “debt service only”, Each of which may give rise to different considerations. Although DSU is a separate class of insurance from that contained within the material damage section of the CAR [construction all risks] policy, it will normally be provided in conjunction with such cover. 18-002 DSU concerns not the immediate impact of the physical damage on the insured (i.e. the need to repair or rebuild the contract works), but the consequential effect that the damage has on the project as a whole. Because DSU is a separate class of insurance, it will be contained within its own section of policy, with its own definitions, policy limits and period of insurance (the latter being a crucial feature of the insurance) … Although it bears obvious similarities to business interruption cover, having developed from and being based on standard precepts from BI, there is a significant practical difference between the two types of insurance, because in the case of DSU there will be no historical record of the profitability of the insured's business, which (by definition) will not have commenced commercial operations at the time the claim arises.”
“Section A: Property Damage & Business Interruption”
“nothing stated that BI was being treated separately and was not insured; contrast where parts of Section A were not operative, for example “rent receivable” and “rent payable”
“The Policy treats Property Damage and Business Interruption together under Section A, and there is only one “Sum Insured” which could sensibly be a “Sum Insured” corresponding to the relevant section – and that is the figure given for Buildings Sum Insured of£900,000 , which was then increased to£1m by endorsement (where the premium is expressly said to be in respect of MD/BI). Pro2Care’s position is that there are two separate indemnities provided by the Section A insuring clause, and so the figure applies separately to each.”
“Section E2 Third Party Bodily Injury£5,000,000 ”; “Section E2 Third Party Property Damage£5,000,000 ”; “Section E4 Legal Defence Costs”; “Section E6 Legionellosis£1,000,000 ”; “Section G Fidelity Insurance£100,000 ”
“This insurance does not apply if shown as not insured in the Schedule”
“Property Damage insurance” and “Business Interruption insurance”
““unless shown as not insured in the Schedule” reiterate that if there is no cover, then this will be specifically identified on the Schedule. The Schedule says the opposite. It said “insured” under “Property Damage & Business Interruption”, and it does not disapply the Gross Revenue method of calculation.”
“The period, beginning when the Damage occurs, ending when the results of the Business cease to be affected by the Damage, but not exceeding the Maximum Indemnity Period (as shown in the Schedule)”
“Probitas’ Skeleton persists with the submission that there was no business, because there was no revenue before the Water Damage, and somehow the description of the Business on the Schedule demonstrates that there was no business at the time. With respect, this is nonsense and does neither Probitas nor its legal team any credit. Almost every business has a lead in time while it is developing or purchasing the assets it needs to earn revenue; they are no less operating a business during the time that they're setting up, than after they have their first paying customer.”
“Reinsurers seek to rely upon an implied term to limit the word “business” in the BI section of the policy to “business which was being carried on by the assured during the period of the policy” having previously asserted an implied term limiting it to business carried on at the date of damage. In my judgement the implication of either term is not necessary not even reasonable.”
“It requires a representation, in words or conduct, which must be unequivocal and must have been relied upon in circumstances where it would be inequitable for the promise to be withdrawn”
“Further to the complaint raised with Lloyds, please see below the final response. I understand from this that you are happy to consider the BI claim and require further information to assess the loss. I can send you a copy of our business plan with our financial forecasts, our submitted accounts to Companies House and if required can have management accounts prepared. The property damage claim is in process … If you anticipate the review of the BI claim to take long, can any interim payments be made to cover urgent bills and salary?”
“From my perspective the complaint is now resolved. My claims colleagues will now assess the BI claim and will be in touch as to what you need to provide to evidence loss of earnings. @Stephen Holmes please could you get in touch with Mr Malik on this.”
“Thanks for the update [in relation to Property Damage]. I understand from Probitas that the business interruption claim will now be considered following an investigation by Lloyds and that Stephen Holmes has updated you regarding this. This may have implications on your tender review … While the business interruption and tender is under review are we entitled to any interim payments to cover our urgent bills such as the property loan repayments and salary?”
“Please tell me what you need from me in order to assess the business interruption claim? I can send you our business plan which includes the financial forecast from February 2023 and I can also send the accounts we submitted to Companies House. I can also have management accounts prepared if required.”
“Did you ascertain what you need from me for the business interruption claim?”
“Its being reviewed with our accountant and I will get a list to you asap.”
“I might need some time to get the items together, so the sooner I can get the list the better. Are you looking to settle the property damage claim and business interruption together or do you anticipate the business interruption to take a while and therefore settle the property claim first? Are you still going to come back to me this week on the tender?”
“Management accounts would need to be prepared if required, please let me know if you think it will help with the assessment of the claim or will add any value to it?”
“Further to our requests for information surrounding your business interruption claim, we are reviewing with our forensic accounting team to determine if the projections are realistic and achievable. … We have received evidence of your monthly mortgage payments, but no further demonstration of your fixed costs has been provided, which will need you to evidence with appropriate documentation. Please evidence all costs being incurred by the business. We are reluctant to request all management accounts at significant costs if you are able to demonstrate the costs being incurred without them, and on the basis that they are unlikely to give us enough information nation beyond that. Interim Payment Request Based on the matters set out above, we are not in a position to confirm and indemnify business interruption loss at this stage based on the information submitted and therefore cannot request an interim payment under the business interruption aspect of the claim. However, it has been highlighted to us through these submissions that your mortgage account is in arrears and based on your previous e-mail it appears further payment will be due on Wednesday. We can therefore recommend insurers arrange an interim payment of£10,000 without prejudice to liability for any business interruption loss. For the avoidance of doubt, any liability of Insurers for Business Interruption under your policy remains to be determined and Insurers rights are fully reserved in this regard. It should be noted that this payment does not mean your Business Interruption claim is covered. This payment may be offset against the outstanding Property Damage claim.”
“I understand that in line with a previous complaint final response, underwriters have reassessed your business interruption claim, and this has subsequently been declined. … I note as a result of my colleague’s response to your previous complaint, underwriters were asked to reconsider your claim under the remaining terms and conditions of the policy because your policy schedule was unclear as to whether BI coverage had been taken out as part of your insurance coverage. However, as a result of the re-assessment underwriters have concluded there is still no business interruption loss that the policy can respond to … As Lloyd’s indicated in their email of21 March 2024 Insurers have been requested to “reconsider” any Business Interruption claim. Insurers have done so. However, as explained above, there is no Business Interruption cover given in the policy. … Having reviewed your policy wording and the available evidence, I agree that there is no business interruption claims underwriters to consider. Your intended children's care home business was never established or operating. I understand that operating in the sector required an application to Ofsted and such an application had not been made at the time of the insured event. So even if underwriters were to accept business interruption cover in place, there is no BI loss for them to assess as there was no business in existence. As stated above, the loss you are claiming for here would require a specialist policy in the form of delay in start-up cover.”