6 Reasons Why Roof Claims Are Denied & How To Get Them Approved

Prevent thousands of dollars of out of pocket expenses by understanding the main reasons why roof claims are denied and how to get them approved.

why-roof-claims-are-deniedAfter paying your home insurance premiums for years, one of the most frustrating things that can happen to a homeowner is experiencing damage to your roof only to have your roof claim denied! Knowledge is your best weapon when combatting a roof claim denial, so today we’ll be covering some common reasons home insurance claims are denied, and explain how a knowledgeable roofing company can help you not only get your claim approved, but could potentially increase the amount of your settlement by thousands of dollars in legitimate upgrades.

Reasons Why Roof Claims Are Denied By Insurance

When it comes to your roof, home insurance policies include a limited number of causes that are grounds for replacement. However, not all policies provide the same level of coverage and some insurance companies are more flexible than others when it comes to approving claims, so it’s best to do your research and really understand your policy before signing on the dotted line. If you are unfamiliar with the insurance process, we recommend checking out our blog on Navigating Insurance Claims For Your Residential Roof. If your claim is denied, it will very likely be for one of the following reasons:

Wear and Tear

While modern roofing materials are lasting longer and able to withstand harsher conditions, all materials will degrade over time. If you buy a house with 30-year-old composite shingles and it begins leaking after a few years, it’s possible those shingles have simply reached the end of their lifespan. This is especially true if the previous homeowner failed to do regular maintenance. Wear and tear happen, so if you are buying a property with an older roof, be aware that natural degradation is not covered under your home insurance policy and should be factored into your budget or negotiated with the homeowner prior to purchase.    

Previous Damage

In many areas of the country, it’s unlikely to go 30 years without a storm that causes enough damage to warrant a roof replacement under a standard home insurance policy. However, bear in mind that your home insurance policy will not cover damage that occurred under 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 deny your claim based on the fact that previous damage is the main source of the issue.  

Partial Damage

In order for insurance to approve a claim for a full roof replacement, the Insurance Adjuster needs to determine that enough damage has occurred to the roofing system that a partial repair cannot restore the roof to its previous condition. Unfortunately, the criteria for determining partial damage varies from insurance company to insurance company, and ultimately can come down to the Insurance Adjuster who is sent to inspect your roof. This can be one of the most frustrating scenarios for homeowners after a storm, when homes throughout your neighborhood are being approved for roof replacements, but your insurance company has denied your claim. Because the determination for partial damage is largely subjective, partial damage is one of the most likely denials to be overturned.

Manufacturers Defect

While manufacturers will try their best to maintain quality control on their products, sometimes defective products make their way onto your roof, and will degrade long before the intended life expectancy. If it’s determined that a manufacturer defect is the cause of your roofing system failing, your home insurance provider is not responsible for replacement costs. However, almost all major manufacturers of roofing products have a standard limited warranty provided with the purchase of their products. What that warranty covers depends on the specific manufacturer and what warranty you have selected, so make sure to speak to your roofing contractor about warranties with additional coverage prior to installation.    

Claims Filed Too Late

Most home insurance policies include language that states that a claim must be filed within a reasonable time, and damaged property must be replaced within 365 days from the time damage was incurred. If you fail to do so, or neglect to notify your insurance company in writing prior to the 365 days expiring, along with a valid reason for the delay and an extension request, they are likely to deny your claim. Insurance inspections after suspected damage often come at no charge to the homeowner, so avoiding a denial based on timeliness is often as simple as requesting an inspection and meeting with your Contractor of Choice.  

Insurance Adjuster Interpretation

Whenever you have a roof inspection completed by your Insurance Adjuster, it’s important to understand that an Insurance Adjuster is not a professional roofer or contractor, and their expertise is often limited to the training they receive from the insurance company. Even the most well-intentioned Insurance Adjuster can miss signs of damage that could result in your claim being approved simply from lack of knowledge. This is why it’s always a good idea to have your Contractor of Choice meet your Insurance Adjuster on-site for the inspection, as we are able to point out damage, and explain why it should be covered by insurance before it’s denied.

Appealing A Claim Denial

If your original claim is denied there’s an appraisal process you can take as the insured to get the denial overturned.  Be aware that doing everything in your power to avoid a denial, such as having your contractor on-site for the inspection, is in your best interest as the appeals process can take time to come to a resolution.

Once your claim is denied, there is a time limit to appeal the decision, which you can learn about by contacting your Insurance Company. An appeal should ALWAYS be done in writing. You should also ask for a resolution date in writing to minimize the length of time the appeal process takes. After requesting an appeal, the insurance company will often send out another Insurance Adjuster for a second opinion. At this time, we STRONGLY recommend having an experienced Roofing Contractor on-site, or even a Public Adjuster who can serve as an unbiased 3rd party representative. If you choose to hire a Public Adjuster, know that this will be done at your expense, and will not be reimbursed by the insurance company.

Whether you use your Roofing Contractor or a Public Adjuster, evidence needs to be compiled to prove damage occurred that warrants approval under your current policy. If the second Insurance Adjuster also denies your claim, the appeal will need to be elevated to a Claims Manager. As a last resort, your options are either to file a complaint through the state, or to hire an Attorney.  

roof-claims-denied-and-how-to-get-them-approvedUnderstanding Roofing & Building Code

The importance of hiring an experienced Roofing Contractor isn’t just getting your claim approved, but getting the most value out your claim. Over time, Local and International Building and Roofing Codes are updated, and these updates can be covered if your insurance policy includes code coverage. These are especially valuable for older homes, as code upgrades can result in thousands of dollars of protective and energy efficient aspects being added to your claim that don’t currently exist on your home. International Building and Roofing Codes are extremely technical and lengthy documents, and code upgrades are likely to be missed if they aren’t examined by a Roofing Contractor who is intimately familiar with local code requirements.

Additionally, repairs for roof damage aren’t exclusive to the exterior of your home. When a leak occurs, it can damage the interior of your home as well, and interior damage that is a direct result of a roof leak can also be covered by your home insurance if the exterior claim is approved. An experienced Roofing Contractor will take the time to perform a thorough inspection on the interior of your home as well if a leak is suspected, and coordinate the repairs of both the exterior and interior of the home.

Get Your Claim Approved With A Knowledgeable Roofing Contractor  

Your best weapon in avoiding a claim denial by your insurance company is knowledge, and an experienced roofing contractor will have all the tools and knowledge you need to get your claim approved. Your Insurance Policy allows you to work with your Contractor of Choice, so make sure to do your research and work with a professional Contractor who will guide you throughout the entire process from filing a claim through final inspection, allowing you to get the most value out of your home insurance policy.

If you have any questions about the insurance claims process, or would like our world class  team to come inspect your home, give us a call or contact us via our contact page.   

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