What if my claim gets denied?

In 15 years running an insurance agency, I sat across the desk from a lot of homeowners holding a denial letter. Most of them were frustrated, and almost all of them had the same question: “Is that it?” Sometimes it is. Sometimes there’s more to understand. Here’s how I’d think about it.

Read the letter, slowly

A denial letter should tell you two things: why the claim was denied, and which part of your policy the decision is based on. Read it twice. Then find that section in your own policy and read it too. Policy language is dry, but this is the part that matters.

The usual reasons

Every policy and every claim is different, but roof denials tend to come back to a few things:

• Wear and tear. The damage was judged to come from age, weathering or long-term wear, not a storm.
• Cause not covered. The damage came from something your policy excludes, like a maintenance issue or an old installation problem.
• Timing. The damage didn’t line up with the storm date, or it was reported long after it happened.
• Below the deductible. Technically not always a denial, but the damage cost less than your deductible.
• Policy terms. Some policies have specific limits or exclusions for roofs. Your declarations page and endorsements will show them.

Questions worth asking

You’re allowed to ask questions. In my experience, homeowners who ask calm, specific questions get clearer answers.

1. What exactly was the decision based on: the inspection, photos, the policy language, or all three?
2. Was the whole roof inspected, or a sample?
3. Is there information you didn’t have that you would consider?
4. Can the roof be re-inspected?
5. What options does my policy give me if I disagree?

Your agent is a good person to call here. They can help you understand what your policy says, even though the claim decision belongs to the insurance company.

Options people commonly use

Depending on your policy and your state, homeowners commonly:

• send in more information, like dated photos from before and after the storm or documentation from a contractor,
• ask for a re-inspection,
• use the appraisal provision many homeowners policies include for disagreements about the amount of a loss,
• contact their state’s Department of Insurance, which has consumer resources, or
• talk to an attorney about legal questions.

Some homeowners also hire a licensed public adjuster. That’s their decision to make.

Where we fit

If we inspected your roof, we can share our photos and the scope we prepared, and we’ll walk you through exactly what we saw. If you want us to, we handle communication with your carrier about the documentation and scope, and we’re there if the roof is re-inspected.

And we’ll be straight with you. Sometimes, when I look at a roof after a denial, the honest answer is that it’s just old. The storm didn’t cause the problem; twenty years did. If that’s what we see, we’ll tell you, and if the roof needs replacing anyway, we’ll price it plainly so you can make a decision with real numbers.

The bottom line

A denial isn’t always the end of the conversation, and it isn’t always wrong either. Read the letter, ask good questions, gather what you have, and understand your options. Your job is to make sure the decision is based on the full picture, and our job is to tell you the truth about your roof.