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This is what to do immediately if your roof insurance claim is denied

Roof insurance claim
Roof insurance claim

After years of paying home insurance premiums, one of the most aggravating things that can happen to a homeowner is sustaining roof damage only to have your roof claim denied! When it comes to fighting a roof claim denial, knowledge is your best weapon, so today we’ll go over some of the most common reasons home insurance claims are denied, as well as how a knowledgeable roofing company can help you not only get your claim approved but potentially increase the amount of your settlement by thousands of dollars in legitimate upgrades.

Getting your storm-damaged roof repaired through insurance is stressful enough. However, having your claim denied adds to the stress. Unfortunately, this occurs frequently. And when it does happen, homeowners are left with more questions than answers. But keep in mind that an initial denial does not have to be the end of the story. So, what should you do if your insurance provider rejects your roof claim?

Table of Contents

Why would your insurance company deny your claim?

Before we get into what you can do, consider why your roof damage claim was denied in the first place. Unfortunately, your insurance carrier may deny your claim for a variety of reasons. The following are some common reasons why insurance companies deny roof damage claims:

  • Wear and Tear: While contemporary roofing materials endure longer and can handle harsher weather, all materials degrade over time. If you buy a property with 30-year-old composite shingles and it starts leaking after a few years, the shingles may have simply reached the end of their useful life. This is especially true if the previous owner neglected to do routine maintenance. Natural degradation is not covered under your house insurance policy and should be incorporated into your budget or negotiated with the homeowner before purchasing if you are purchasing a property with an older roof.   
  • Previous Damage: In many parts of the country, 30 years without a storm causing enough damage to trigger a roof repair under conventional house insurance coverage is rare. Keep in mind, however, that your home insurance coverage will not cover damage caused by a previous policy. Home insurance will only cover damage caused by the most recent event, so if a combination of old and new damage is causing your roof system to fail, they may refuse your claim because earlier damage is the root of the problem.
  • Partial Damage: The Insurance Adjuster must conclude that enough damage has occurred to the roofing system that a partial repair cannot return the roof to its prior state before insurance will authorise a claim for a full roof replacement. Unfortunately, the criteria for recognising partial damage differ from one insurance company to the next, and it may finally come down to the Insurance Adjuster who is appointed to evaluate your roof. When homes in your area are authorised for roof replacements, but your insurance company has refused your claim, this can be one of the most stressful scenarios for homeowners following a storm. Due to the discretionary character of the assessment for partial damage, partial damage is one of the most probable denials to be reversed.
  • Manufacturers Defect: While manufacturers make every effort to maintain quality control on their products, occasionally defective materials make their way onto your roof and degrade well before the intended life expectancy. If it is determined that a manufacturer flaw caused your roofing system to fail, your home insurance company will not cover replacement costs. However, practically all major roofing product manufacturers include a standard limited warranty with the purchase of their products. What that warranty covers depends on the manufacturer and the warranty you choose, so talk to your roofing contractor about warranties with additional coverage before installation.
  • Claims Filed Too Late: Most home insurance policies include language stating that a claim must be filed within a reasonable time frame and that damaged property must be replaced within 365 days of the date of damage. If you fail to do so, or if you fail to tell your insurance company in writing prior to the 365-day period expiring, along with a valid cause for the delay and a request for an extension, they will most likely refuse your claim. Insurance inspections following suspected damage are frequently free of charge to the homeowner, thus avoiding a denial based on timeliness is frequently as simple as scheduling an inspection and meeting with your Contractor of Choice.
  • Insurance Adjuster Interpretation: When your Insurance Adjuster performs a roof inspection, keep in mind that an Insurance Adjuster is not a professional roofer or contractor, and their knowledge is typically restricted to the training provided by the insurance company. Even the most well-intentioned Insurance Adjuster can overlook indicators of damage, resulting in your claim being approved due to a lack of understanding. This is why having your Contractor of Choice meet your Insurance Adjuster on-site for the inspection is always a good idea, as we can point out damage and explain why it should be covered by insurance before it’s refused.

Most of these causes, unfortunately, are beyond your control. However, your insurance company should explain why your claim was denied.

Appealing A Claim Denial

If your initial claim is denied, as the insured, you can go through an assessment process to get the refusal reversed. Be mindful that doing everything possible to avoid a refusal, such as having your contractor on-site for the inspection, is in your best interests, as the appeals process can be lengthy.

If your claim is denied, you have a certain amount of time to appeal the decision, which you may find out by contacting your insurance company. A written appeal should ALWAYS be made. You should also request a decision date in writing to reduce the length of the appeal procedure. Following a request for an appeal, the insurance company will frequently dispatch another Insurance Adjuster for a second opinion. At this point, we STRONGLY advise having an expert Roofing Contractor on-site, as well as a Public Adjuster who can function as a neutral third-party representative. If you decide to hire a Public Adjuster, keep in mind that you will not be compensated by the insurance company.

Whether you utilise your Roofing Contractor or a Public Adjuster, documentation must be gathered to demonstrate that damage happened that is sufficient to gain approval under your present policy. If the second Insurance Adjuster also declines your claim, it must be escalated to a Claims Manager. As a last resort, you can either file a complaint with the state or employ an attorney.

What options do you have if your insurance company denies your roof claim?

After you’ve learned why let’s look at your choices if your original claim is denied. Remember that the majority of the reasons are valid, and there is nothing you can do about it.

However, if your claim is denied because the adjuster claims they didn’t locate any or enough damage, you can double or even triple-examine your roof if you’re certain it was damaged by the storm.

Requesting a different adjuster
The simplest solution is to request that your insurance company send out a different adjuster to obtain a second opinion from a fresh set of eyes. Unfortunately, some insurance companies refuse to provide homeowners with a second adjuster.

But keep in mind that you have the right to a second adjustment. After inspecting your claim, they will either approve it or agree with the first adjuster that there is no foundation for a claim.

Making contact with a structural engineer
If you’re still convinced there’s roof damage and want to pursue a claim after the second adjuster declines, you can contact a structural engineer. They’ll assess the roof and provide documentation to the insurance company that it has to be replaced due to structural issues.

This is only done in exceptional circumstances and is only advised if the insurance adjusters are unreasonable. However, there is still a potential that this will fail.

If this occurs, you will either bite the bullet or seek legal avenues that we are not equipped to undertake.

Understanding the Building Code and Roofing

Hiring an experienced Roofing Contractor is important not just for getting your claim approved, but also for getting the most value out of your claim. Local and International Building and Roofing Codes are revised throughout time, and these updates may be covered by your insurance policy if code coverage is included. These are especially useful for older properties, as code improvements can result in thousands of dollars of additional protective and energy-efficient features being added to your claim that does not currently exist on your property. International Building and Roofing Codes are extremely technical and extensive documents, and code improvements are likely to be overlooked if not thoroughly reviewed by a Roofing Contractor who is intimately versed with local code requirements.

Furthermore, roof damage repairs aren’t limited to the exterior of your home. When a leak happens, it can cause damage to the interior of your home, and interior damage caused by a roof leak may be covered by your home insurance if the exterior claim is granted. If a leak is suspected, a skilled Roofing Contractor will conduct a comprehensive assessment of the interior of your home as well and will coordinate repairs to both the exterior and interior of the property.

Is there anything a roofing contractor can do to get your claim approved?

When their insurance claim is denied, most homeowners turn to their roofing contractor for assistance. So, throughout the years, I’ve had a lot of queries like, “If you indicated I had roof damage, why is my claim being denied?”

The truth is that whether or not the claim is authorised is completely out of your roofing contractor’s hands. They can look for and document signs of storm damage, but the insurance adjuster has the last say on whether your claim is approved or denied.

Even if the roofing contractor is convinced that you require a new roof due to storm damage, the insurance adjuster is the only one who can expedite the approval process. However, this does not imply that your roofing contractor is ineffective during the process.

If you employ an insurance-experienced roofing contractor, they will battle to ensure that your policy is followed. They accomplish this by documenting proof or obtaining hail/wind maps to demonstrate that your residence was in the path of the storm.

However, fighting for you does not usually end once your claim is approved. They will also augment your insurance claim to guarantee that your roof receives all of the necessary repairs.

Finally, a roofing contractor is your partner and advisor throughout the insurance claim procedure. That is why it is critical to pick one with experience and in whom you have faith.

Approve Your Claim With A Skilled Roofing Contractor

Knowledge is your most powerful weapon in avoiding a claim denial from your insurance provider, and an expert roofing contractor will have all of the tools and knowledge you need to get your claim approved. Your insurance policy allows you to work with your preferred contractor, so do your homework and hire a professional who will help you through the entire process, from filing a claim to the final inspection, allowing you to get the most out of your house insurance policy.

Answers to the most frequently asked roof insurance claim questions

You now understand why your insurance claim was denied, what you can do about it, and what a roofing contractor can do for you. Remember that the insurance adjuster has complete authority over your claim.

You should know what to do next for your insurance claim after reading this article. Unfortunately, progressing through the insurance claim procedure simply raises more questions.

Wouldn’t it be fantastic if you could get answers to all of your major insurance questions in one place? Naturally, it would be.


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