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You’ve paid so much premiums for your homeowner’s insurance. Unexpectedly, things went south and you need a roof replacement.
Your expectation: A proper compensation for your roof damage.
The reality: An underpaid settlement, or an outright refusal.
It’s common to get your roof insurance claim denied. This is because insurance companies are a business; they need to make a profit.
But the good news is that denial doesn’t have to be the final word.
Read on to find out what to do.
Common Reasons for Roof Claim Denial
First of all, you might be wondering: why did my roof claim get denied?
Short answer: it depends. You might feel like your insurer is ripping you off, but there are legitimate reasons why a roof insurance claim is denied.
Below are the most common reasons for denying roof claims:
Coverage Limits
Policy or coverage limits refer to the maximum amount of money insurance companies will pay towards roofing claims.
Coverage limits depend on your insurance carrier, insurance type, location, premium cost, etc.
If you filed a roofing claim that’s worth higher than the policy limit, your insurer will most likely reject the insurance claim.
If you’re lucky, they will agree to pay the maximum amount as stated in your coverage limit.
For example, you filed a roofing claim totaling $150,000. But your coverage limit is only $100,000. In such cases, your insurance carrier will most likely refuse to pay the roofing claims.
Non-Covered Perils
A peril is an event caused outside of our control, such as a fire or a windstorm, that leads to damage or loss.
Your homeowners insurance will have a covered peril. That is, if you have any losses or damage due to certain perils, your insurer will provide reimbursements.
The amount of reimbursement and the type of peril covered will depend on your policy. For instance, the most popular HO-3 policy will typically cover only 16 perils unless you buy extra coverage.
Keep in mind that most insurance policies do not cover roof damages caused by wildfire and earthquakes.
That’s why it’s important to know what is excluded from your insurance policy. After all, you don’t want to lock the stable door after the horse is stolen.
Deductible Less Than Claim
Deductibles refer to the amount of money you have agreed to pay prior to the coverage kicking in.
Simply put, if your roof insurance claim is lesser than the deductible amount, your insurance carrier may reject the insurance claim.
For example, your roof damage amounts to $10,000, but you have a $1,000 deductible. This means your insurance company will deduct $1,000 and reimburse you $9,000.
A deductible can either be a specific amount (e.g. $500), or a percentage of the total insurance policy amount. The deductible amount depends on your insurance policy, insurance claim type, and your state.
For homeowners insurance, deductibles are applied every time you file insurance claims. Also, in cases of perils, deductible policies may differ.
Roof Age
The older your roof, the higher the chances of a denial.
Most insurance companies set a roof age limit, and usually, it’s 20 years.
To give you a better perspective, asphalt shingles are one of the most commonly used roofing materials. It’s cheap and easy to install but lasts as short as 15 years.
Because of this, insurance companies can easily argue that your roof damage was caused by depreciation or wear and tear.
However, if the roof damage was caused by some kind of peril (e.g. water damage), it may be possible to ask for a claim regardless of your roof’s age.
It helps to ask for an inspection from a licensed roofing contractor prior to filing your claim. Contractors can assess the severity of damage and provide you with an estimate for repairs.
Negligence
Legally speaking, negligence refers to the failure to act reasonably, resulting in damage or loss.
In homeowner s insurance, the most common negligence is the lack of maintenance. In other words, the condition of your roof can have a significant impact on the insurance claims adjuster’s decision.
For example, the adjuster sees that your roof repairs are way overdue. With this, the insurance company could reject your claim by saying you haven’t been doing the necessary repairs for your roof.
Insurance carriers don’t include basic maintenance. So before filing a roofing claim, check that you don’t have the following:
- Debris/moss
- Mold/mildew
- Roof leaks
- Dirty gutters
- Sloppy roof replacement/repair work
You may also be negligible due to third parties.
What happens if a hired contractor caused damage in your roof? Is your contractor liable too? In such scenarios, check your insurance policy and the extent of your coverage.
Others
So far, we’ve listed the top reasons for a damage claim denial. Below are some uncommon—but entirely possible—reasons.
- Cosmetic damage only: Cosmetic refers to any damage that changes the appearance of a roof. Many insurers have excluded cosmetic damage since it doesn’t take away the main purpose or function of a roof.
- Delayed filing: If you take too long to report your roof damage, insurers may use this as a reason to deny your claim.
- Slow insurance claim process: Sometimes, insurance companies are slow or inefficient. Instead of providing a resolution, some make people wait until they give up and drop the case.
What to Do With Denied Claims
So your claim is denied. But don’t worry, there are ways to dispute denied claims.
Review and Document
Review the roof insurance denial letter. Understand the reasons stated in the denial.
Afterward, check
1) Your home insurance policy, and
2) Documentation provided one more time
It’s easy to miss the fine prints of the insurance policy, so it’s worth going over it one more time. This way, you know exactly what you’re entitled to.
Second, review the evidence (photos, receipts) you’ve initially provided. It’s possible that your insurance company thought they weren’t enough.
With this, gather more evidence. Get pictures or videos of the roof damage, receipts from roofing contractors that did the repairs or replacements, or reports from a roof inspector.
Contact Again
Now it’s time to contact your insurance company again.
Speak with your insurance agent or the company’s claims department, and discuss the estimate provided by the insurance adjuster.
If you found any errors made by the insurance adjuster, make sure to bring this up.
If not, ask if your claim can be reviewed again. Inform them you found new evidence to support your claim, or if an insurance adjuster could re-examine the damage.
Your insurance company will most likely review the claim. If you’re lucky, they may also agree to another roof inspection. If not, you could obtain an external appraiser, or file for an appeal.
Re-Inspection
If you or your contractor feels that some details may have been overlooked, request a re-inspection.
Remember to ask for a different insurance adjuster from the first inspection.
If possible, have your contractor or any other professional (e.g. attorney) with you when the insurance adjuster visits your home.
Property insurance laws are complex, so having someone with more knowledge will definitely help.
Make sure to take note of what the adjuster says, what they say will be covered. These notes will help in case you have to talk to your insurance company again.
Appeal Letter
When your case review doesn’t go well, your last resort is to file an appeal letter.
Before writing the letter, check your insurance policy for the exact process and deadline.
While there is no strict format to follow, make sure to include the following:
- Description of the damage
- Date of denial
- Evidence or documentation to support your claim
- Why you feel the decision is wrong
- Your preferred resolution
- Resolution date
The tone of your letter should be polite (no matter how frustrated you might feel). Having a resolution date gives you the chance to follow up in case they haven’t responded by then.
Appraisal
Homeowners insurance policies aren’t the easiest to understand. Instead of doing things on your own, consider hiring a professional.
Formally, this is called an appraisal. It’s a common procedure taken when it comes to property damage. For this, you would need to hire any of the following:
- Roofing contractor
- Public roof claims adjuster
- Attorney
Keep in mind that similar to appeal letters, appraisals have time limits.
Roofing Contractor
Contractors help determine the details and cause of damage. Contractors can also provide an estimated amount for repairing or building a new roof for your house.
Contractors are also the cheapest way for you to have a professional opinion or evaluation, so it’s the first step you should consider when your claim is denied.
Public Roof Claims Adjuster
Public roof claims adjusters will assess and evaluate the material costs of your roof damage.
They handle the homeowner insurance claim process from start to finish. As such, they can help you with the necessary paperwork so that you can get the maximum amount of money you’re entitled to.
A public adjuster will cost a percentage (typically 10% to 20%) of the homeowner insurance settlement.
However, the good news is that many public adjusters only get paid once you have accepted the final settlement from your insurance company.
This means on-site visits and assistance to file a claim will usually be free of charge.
Home Insurance Claim Attorney
If you’ve done everything possible, but reached a tail-end, it might be time to hire a home insurance claim attorney.
Many states do not allow public adjusters to negotiate insurance claims. So a home insurance attorney can look at your case from a litigation standpoint and act as your spokesperson during the rebuttal process – in and out of court.
Attorneys usually get paid on a contingency basis, which means you pay a certain percentage (typically 33% to 40%) once you have accepted the final settlement amount.
Ultimately, a home insurance attorney is only beneficial if your claim is complex, and the damage amount is high. Otherwise, the costs will outweigh the benefits.
Conclusion
Your homeowners insurance is supposed to protect you from unexpected damages and costs. But you find yourself in an unfair situation where your claim was underpaid—or worse—denied.
In these cases, review the claim denial thoroughly and talk to your insurance company for a reconsideration.
It also helps to hire a public claims adjuster or a home insurance attorney to help you throughout the whole process.
