roof insurance claim denied

What to Do if Insurance Denies a Roof Claim

Ideally, your insurance provider should pay for most types of roof damage, as long as they are caused by events beyond your control. But what if your insurance company refuses to foot the bill? Here’s how you can appeal a denial to your claim for roofing replacement or repairs.

Why Are Claims Denied?

The insurance claim process is not always simple. Whenever you file a claim for roof damage, there are a few people involved in the approval or denial process. In addition to you, the homeowner, most claims involve an adjuster who is basically a representative for the insurance provider. This person will essentially help make a final decision and, if he or she chooses, eventually cut you a check to pay for the repairs. The third party is the professional roofing contractor, who will inspect the damage and go about fixing your roof.

But approval is anything but certain. Many insurance policies have strict provisions and surprising exclusions. This is why it’s very important to thoroughly read over your policy before you attempt to file a claim.

Indeed, not every type of roof damage meets the strict coverage terms laid out by insurance policies. Here are some of the most common reasons claims are denied:

  • The cost to fix a roof is less than the deductible amount.
  • The company has a different deductible for hail or wind claims.
  • Coverage excludes damage caused by earthquakes, wildfires or other specified causes.
  • Damage was determined to result from inadequate maintenance.
  • The roof has already reached or surpassed its expected lifespan.
  • The roof has already suffered previous damage.
  • Damage was determined to be the result of a manufacturer’s defect.
  • Your claim was filed too late.
  • The adjuster determines that the roof has only suffered partial damage which doesn’t warrant a full replacement.

Ultimately, the insurance claim approval process comes down to the insurance adjuster’s interpretation of the damages. It’s important, however, to understand that insurance adjusters are not professional roofers. In turn, their expertise is usually limited to the training they get from the insurance company. Even an honest, well-intentioned adjuster can miss signs of roof damage that could cause your claim to be denied.

This is why it’s always best to have a reputable roofing contractor meet your adjuster on-site for the entire inspection. This way, they can point out damage and explain why it should be covered before it’s denied. And even if your claim is denied, state laws require insurance providers to establish a fair appeal process that gives homeowners a chance to argue their case.

woman looking at insurance claim denied

Appealing a Denial

If your claim is denied and you disagree with the decision, contact the insurance provider and schedule a re-inspection. During this second inspection, have a reputable local roof repair contractor on-site to document the damages alongside the insurance adjuster. You may find that some of the roofing damage was overlooked during the first inspection.

Understand that the claim handler may ask for photos or other evidence before sending out another rep. In certain instances, roof repairs or outright replacements may even be approved based solely on the photos if the damage is clearly evident in the pictures.

Most insurance dispute processes require the homeowner to file an official appeal with the company. When you submit your appeal, ask for a specific resolution deadline. The whole rebuttal process can be frustratingly slow and you may have to tap your feet a while before you hear back. If the deadline passes without an update, follow up with your insurer. If you are denied, you can still dispute this action further by asking to speak to the insurance company’s superiors or by filing a complaint with your state’s regulatory agency.

How to Improve the Odds of Approval

If you want to increase the chances of a successful insurance claim, it’s best to hire a professional roof repair contractor to assess the damage before you contact your insurance company. A seasoned contractor will be able to identify the degree and causes behind roof damage. This can be very useful when providing compelling evidence to the insurance provider. An experienced roofer can also provide an accurate quote to replace the roof or repair any damage.

Some companies, such as A to Z Roofing, will even work directly with your insurance company to streamline the approval process on your behalf. For questions on roof insurance claims, roof repair or restoration, contact us today!

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