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Because you have homeowners insurance, you might assume that your roof repair or replacement will automatically be covered. But some insurance companies are less flexible than others when it comes to criteria for covering repairs or replacement. Therefore, you may file a claim, expecting that the expenses associated with fixing the damage will be covered, only to get a denial in response

You do have options if your insurance denies your roof claim. 

Understand the Reason for the Denial

If you want to appeal the denial, you’ll need information on your side. Understanding why the claim was denied can help you fight it. Familiarizing yourself with the exclusions on your insurance policy can help you determine whether you can appeal the denial or not.

Wear and Tear

Roofing materials are designed to last a long time. However, they’re not completely permanent. Different materials have distinct lifespans, and they all undergo wear and tear over the years. If you have roof damage from natural weathering. Therefore, if you file a claim for a leak on a 30-year-old roof, it might not be covered because the roof has simply reached the end of its lifespan. 

Neglect of Maintenance

All roofing materials have specific maintenance requirements to help them protect the property for as long as possible. If lack of maintenance has contributed to the damage, your claim might be denied. Therefore, it’s important to keep your roof in good condition. Hiring a roofing company to conduct an inspection at least once a year can tip you off to maintenance needs that prevent damage.

Some signs that you have neglected to maintain your roof include:

  • The presence of mold, mildew or fungus on the roof
  • Interior water damage from ongoing leaks
  • Animal infestations

 

Your insurance company may also deny your claim if you have performed inadequate maintenance. For example, if your shingles were falling off because of general wear and tear but you caused a leak by nailing them back in yourself, you may have created more damage.

Pre-Existing Damage

If you purchase a new homeowner’s policy on an older home, it may not cover damage that was incurred under the previous policy. Therefore, you should make sure that you work out coverage for existing damage when you purchase a home. This may be something that you negotiate with the seller.

However, coverage may only be denied if the pre-existing damage is the main source of the current problem. If you can prove that a more recent event is the primary cause for the roof system failing, you may be able to appeal.

Manufacturing Defects

Sometimes, defective products or installation methods cause roof systems to fail prematurely. In these cases, the insurance is not responsible for covering the damage. However, your roofing materials come with a warranty. You should familiarize yourself with the details of the warranty to determine whether the manufacturer will cover the repairs. Also, ask your installer about their guarantees before hiring anyone to perform roofing work.

Timing

All insurance policies have a statute of limitations for filing claims. The time period starts with the date of the loss, such as a hailstorm or hurricane. The statute of limitations differs depending on the policy and your state. Although your state may indicate that you have several years to file a claim, the insurance company may have different requirements. Most insurance policies require you to file a claim within one year of the date of loss.

Therefore, it’s always recommended to file a claim as soon as possible after the incident. Furthermore, acting quickly will prevent further damage on an already impaired roof. If you do wait to file a claim, you should have a solid justification for the delay. 

Steps for Responding to a Denied Roof Claim

It can be worrisome and frustrating to receive a roof claim refusal. You might have no idea what to do if insurance denied your roof claim. The following steps provide guidance for moving forward:

  • Contact the insurance provider – Let them know that you’d like to appeal the refusal, and find out how long you have to file the appeal.
  • Hire a professional roofing company – An independent roofing company that doesn’t work with the insurance provider can provide an objective assessment of the situation. An impartial inspection can evaluate the cause and degree of damage. They will also be able to tell you whether you have a valid case for initiating an appeal.

 

How to File an Appeal

Time is of the essence when initiating an appeal. Just like your insurance policy limits the time in which you can file a claim, it also has requirements for filing an appeal. File the appeal in writing, and include any documentation or photos that you have of the damage.

After you file a dispute, the insurance company will likely send an adjuster out to reinspect your roof. However, insurance adjusters are not professional roofers. They may be able to record the damage or take photos, but they won’t have as much information as an industry expert. Therefore, you should have an experienced contractor join the adjuster to provide more context and information about the damage that the adjuster might have missed.

Ask the insurance company for a resolution date. Contact them on this date to learn their decision. If the insurance provider fails to notify you of a decision by this date, it could help you establish a bad faith case, in which you may be entitled to increase the amount of your original claim.

Document everything. If you’re not comfortable doing this on your own, you may want to hire an insurance lawyer. An attorney can take care of all communication with the insurance company, maintain compliance with local laws and generate reports to support your claim.

What if You Can’t Reverse the Decision?

It’s not in the insurance provider’s best interest to cover your claim. And in some cases, they may have valid reasons for denying it. 

If insurance denied your roof claim as well as the appeal, you’ll have to find an alternative way to cover the expense of repairs. This often means paying out of pocket. 

But you still have some options. You may not have to replace the entire roof. Have a professional roofer inspect the damage and let you know if you can perform minor repairs until you can afford to get the entire roof replaced. 

You may also be able to work with the roofer on a payment plan. If you plan to stay in the property for a long time, you’ll be better off paying for high-quality roofing materials. However, if you plan to move in the next five years or can’t afford high-end materials, look into less expensive options. 

Reducing the Risk of Denied Claims in the Future

When you get a new roof or initiate a new insurance policy, you can protect your investment by reducing the risk of refused claims in the future with the following tips:

  • Ensure proper installation
  • Perform and document regular maintenance and repairs
  • Take action quickly when you notice a problem
  • Increase your insurance coverage
  • Keep your gutters and other roof accessories in good repair

 

If dealing with your insurance company has you confused, contact Presidio Roofing for a consultation. Whether you need an inspection, have a maintenance request or need roof repairs or replacement, we have the experience to meet your needs.