Homeowners Insurance Roof Damage Claim Denial: What Comes Next?

Some claims get denied because of pre-existing damage. Others get denied because of lack of maintenance or policy exclusions. It seems like the insurance companies find many excuses to deny valid claims and these reasons might not be factual, even if an engineer has been called out to write a report.

If your claim gets denied, it’s not the end of the road: there are steps to take to reverse a denied insurance claim and get the compensation you deserve.

Top 7 Most Common Reasons for Roof Insurance Claim Denials

Insurers routinely deny roof damage claims.

Many denials are legitimate. Homeowners have a duty to maintain their roof, for example, and failure to maintain your roof can lead to a denied insurance claim.

Other denials, however, fall into a “gray area.” How do you prove roof damage was caused by a recent hailstorm and not pre-existing damage? How do you prove you performed adequate maintenance on your roof? These are all questions you need to answer to resolve an insurance dispute.

Here are the top seven most common reasons a roof insurance claim gets denied:

1. Wear and Tear: Insurance covers sudden, unexpected events – like windstorm damage. It doesn’t cover general wear and tear. Over time, your roof is exposed to the elements, experiences wear and tear, and needs to get repaired or replaced. Insurance doesn’t cover wear and tear.
2. Pre-Existing Damage: If your roof has pre-existing damage, then insurance could deny or reduce your claim. If last year’s windstorm damaged shingles, for example, and you failed to repair that damage or notify your insurance company, then your insurance could deny a new insurance claim. The pre-existing damage made the current damage worse, and your insurer is not obligated to pay for this damage.
3. Lack of Maintenance: As a homeowner and policyholder, you have an obligation to maintain your property. If you fail to maintain your property, and this lack of maintenance causes damage, then your homeowners insurance company will reduce or deny your claim.
4. Excluded Peril: Homeowners insurance doesn’t automatically cover all types of room damage. Some roof damage occurs because of an excluded peril. Those living in coastal regions of the southeastern United States, for example, may need special hurricane or windstorm damage. Otherwise, insurance may not cover hurricane damage to your roof.
5. Manufacturing Defects: The components on your roof could have manufacturing defects, and these defects may have contributed to the damage. Your insurance may not be liable for covering damage related to manufacturing defects. Instead, this damage could fall under your roof warranty. Contact your roofing contractor to ask about warranty coverage.
6. Taking Too Long to Notify Your Insurer: You have an obligation to notify your insurer of your roof damage within an appropriate length of time. If you take too long to file a claim, then your insurer could deny your claim. Typically, you have up to 2 years to file an insurance claim, but check your policy to make sure. Some coastal areas only allow 360 days from the date of loss.
7. Failing to Mitigate Damage After the Initial Event: After your roof experiences damage, you may need to take steps to mitigate future damage. You have an obligation, per the terms of your insurance policy, to mitigate future damage if safe to do so. If a tree tears a hole in your roof, for example, then you may need to put a tarp over the hole to prevent water from entering your home. If it’s safe to do so, you need to take steps to mitigate future damage (or hire emergency restoration contractors to prevent future damage).

What to Do After Roof Damage Insurance Claim Denial: Step-by-Step Guide

Your insurance company has denied your roof damage insurance claim or given a disappointing offer. What happens next?

Your insurance claim isn’t over; you have options for disputing the claim, negotiating a higher settlement, and pushing back against your insurance company.

Here’s the step-by-step guide you need to follow after your roof damage insurance claim was denied:

Step 1) Review the denial, then check your insurance contract. First, you need to understand why your insurance claim was denied. Check your insurance company’s denial, then review your policy. All policies have exclusions and specific terms. Your insurer may have denied your claim because of pre-existing damage or a non-covered peril, for example. Don’t automatically take the insurance company or its representatives’ word for it. Always get an opinion from someone that has your best interests in mind.

Step 2) Contact your insurance company. If you believe your insurance company denied your claim without good reason, then contact your insurance company to clarify the issue:

• Request more information about the denial – like why the claim was denied.
• Ask your insurer for specific proof behind their denial – like proof the damage occurred because of a non-covered peril or was related to wear and tear.
• Inform your insurer you disagree with their findings and plan to dispute your claim.

Step 3) Dispute the claim. Homeowners insurance contracts have a formal dispute process – like an arbitration clause. This clause states both parties have the right to dispute a claim. Different insurers have different dispute processes. The dispute may start with a case review, then proceed to a full arbitration dispute. Typically, here’s what happens when you dispute a roof damage insurance claim denial:

• The insurer sends an adjuster to your property to re-evaluate the roof damage.
• The adjuster may find new evidence proving you were right, leading them to overturn the denial. Or, they may find no new evidence and confirm the original ruling.
• If you disagree with the adjuster’s re-evaluation, then you may wish to invoke the arbitration clause and open a formal insurance dispute. However, proceed to the next step first.

Step 4) Hire a qualified roofing professional to examine your roof. Your insurance company’s adjuster is not a roofing professional. They’re an insurance professional. They may have incorrect opinions on why certain damage occurred. Hire a roofing professional to check your roof damage and confirm the insurance company’s findings. The roofing contractor could verify the damage occurred because of a covered peril, disuniting the insurer’s findings.

Step 5) Hire a public adjuster or insurance attorney. If the insurance company disagrees with your findings and disputes the roofing professional’s evaluation, then it’s time to hire legal assistance. Hire a public adjuster or insurance attorney to formally dispute your insurance claim. Typically, it’s in your best interest to hire a legal professional for disputed amounts greater than $10,000. Attorneys and public adjusters usually work on a contingency basis. An attorney would charge 40%, while public adjusters typically charge much less than that.

Final Word: Contact ClaimsMate for Experienced Roof Claim Assistance

ClaimsMate’s adjusters have resolved roof damage insurance claims, achieving optimal outcomes for policyholders.

If your insurer has denied or reduced your claim, then you have options. Contact a public adjuster to explore your options and get the resolution you deserve for your denied roof damage insurance claim.

Stephanie Corona

Stephanie is a property insurance claim expert with over 20 years of experience working as an insurance adjuster, expert witness, appraiser and umpire. She is passionate about sharing her expertise, knowledge, tips and training to help both property owners and Public Adjusters in their pursuit of effectively managing claims and recovering the claim settlement they deserve after a loss.