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What To Do If Insurance Denies Your Roof Claim?

Learn About How To Deal With Your Insurance Company After They Deny Your Roof Claim.


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Insurance Companies Don't Want To Pay You

Buying or building a house is among the biggest investments you will make in your life. Because owning a property is no mean feat, this is something you want to take all actions to protect. One form of protection is getting home insurance.
In a perfect world, once your premiums are paid, you should make a claim that should be approved. Unfortunately, home insurance is a lot more complex than that.
water damage on roof found while documenting insurance claim

While insurance is supposed to relieve your stress in case of an eventuality, it sometimes becomes a source of stress and frustration when a roof insurance claim is denied. Essentially, when a claim is denied, the burden of replacing or repairing the damaged part of your house solely lies with you.

In this article, learn why claims are denied and what to do if insurance denies your roof claim.

Why Do Insurance Companies Deny Roof Claims?

Granted, insurance policies can be lengthy, jargon-filled documents that most of us would rather not read. However, all the terms and conditions are stipulated therein.
Some of the main reasons behind rejected roof claims include:

Wear And Tear

Wear and tear pertain to degradation that naturally happens to an object with its everyday use. Simply put, any item purchased and used will get progressively damaged over time.

The roof manufacturing technologies we have today can build roofing materials that can withstand the harshest conditions even for decades. However, the components used to build these materials will degrade over time.

Take a scenario where you purchase an old house with a 25-year-old roof, and it begins to leak a few years after purchase. It is possible to argue that the shingles have reached the end of their lifespan. If you or the previous owner has failed to carry out proper maintenance for the roof, this is even more so.

Therefore, if you choose to buy an old property, be aware that your policy is unlikely to cover the natural degradation on your roof. As such, you can either budget to install a new roof when the time comes or request the seller to install a new roof before purchase.

Previous Damage

For example, in many countries, a 30-year roof is unlikely to have escaped a storm strong enough to warrant a roof replacement under a standard policy. Note, however, that one policy cannot be used to repair damage suffered when under a previous policy. An insurance policy will only pay claims resulting from the most recent event.

As such, if your roof is failing due to years of expected damage (wear and tear), combined with new damage, your insurer is likely to reject this claim based on the old damage being primarily to blame for the current state of your roof.

Partial Damage

For an insurance company to approve a claim allowing a full roof replacement, their adjuster needs to determine that there has been enough damage on the roof to warrant an overhaul. The damage has to be significant enough that a partial repair is not considered enough to restore the roof to what it was.
To further complicate matters, the criteria used to make this determination vary from one insurer to another. So much so that the entire decision can solely be based on the adjuster that did the inspection.

It’s not uncommon for a homeowner to find themselves at crossroads after a storm. Imagine a scenario where most of your neighbors get approved for a roof replacement, and your insurance denies your roof claim despite similar circumstances and damage.

All is not lost, however. Because of its arbitrary nature, partial damage is among the easier insurance claim rejections to overturn.

Manufacturers Defect

Manufacturers do their best to maintain quality control of all their products. However, even with stellar quality control mechanisms in place, a defective product or two can still make its way to the market.
If these end up on your roof, the roof will undoubtedly degrade before its expected life expectancy lapses. Therefore, if your insurer can determine that a roofing system is failing due to a manufacturing defect, they have cause to reject your claim.
Fortunately, most roofing product manufacturers have a set limited warranty offered to the purchasers of their products. What is covered in this warranty is dependent on the warranty you pick and the manufacturer.

Warranties can get a bit dicey to navigate, and it’s advisable to talk to your Colorado roofing contractor to guide you on warranty types and additional covers before roof installation.

Late Claims

Most policies have time stipulations that require claims to be made within reasonable timelines and that damaged property must be replaced within 363 days of an eventuality.
If you fail to inform your insurer of damage within 365 days, your claim can be rejected. In the event of a delay, you should notify your insurer in writing, explain valid reasons for your delay, and request an extension.

As much as possible, get in touch with your insurer immediately your roof suffers some hail or storm damage. An insurance inspection is often conducted at no cost to the homeowner. Taking swift action can help prevent rejection.

Adjuster Interpretation

Once you suffer roof damage and reach out to your insurer, they will send you an adjuster to assess the damage. Adjusters are not trained contractors or professional roofers themselves. Instead, they do their investigations based on training received from the insurer.
While they try to do a thorough job, they will often miss clear signs of damage. This can cause your claim to be rejected. It’s always wise to have your contractor present during such an investigation. Being professional roofing experts, your contractor can point out all damage to your roof and explain why your claim should be honored.

Exclusions And Deductibles

Every policy comes with exclusions or things that are not covered under your policy. For example, a policy can exclude wildfires and earthquakes from your policy.
If damage is suffered from such exclusions, your insurer has the grounds not to honor a claim.
Similarly, if the cost to fix your roof is lower than the deductible amount, your claim may be rejected. Most policies will have different deductibles for wind or hail claims, and these are often higher than deductibles for other claims.

How To Fight A Denied Roof Insurance Claim

A denied claim is not always the end of the road, as you can appeal to overturn this decision.
Once a claim is denied, there is a window period where you can appeal. Be sure to find out what the allowed time is from your insurer.
Have your appeal down in writing, and request for a resolution date in writing. This should help minimize the waiting time. Once your insurer receives your appeal, they will often send another adjuster to investigate the property.
When this happens, it’s strongly advised that you have a roofing contractor or a public adjuster present. This will be at your own cost but is well worth it. Whichever way, these professionals will help you gather enough evidence to show that your claim should be paid.
If this appeal is denied as well, you can escalate your appeal to the claims manager. If the appeal is unfavorable, you can hire an attorney or lodge a complaint via the state.

Call Us With Questions Or For Assistance

The appeal process can be tedious, lengthy, and can get costly. Therefore, your first line of defense should be to get your claim approved at the initial application. With our years of experience, we can help you navigate the complex insurance processes and give you better chances of making a successful claim.
If you just suffered some roof damage, don’t take your chances: call us and let us work our magic.