Cincinnati and northern Kentucky experience volatile weather throughout the year, ranging from heavy snow one week to hailstorms the next. If you’ve ever walked outside after a storm to see loose shingles, you know how damaging severe weather, fires, and other events can be to your roof.
Your homeowners insurance can help with money for repairs, but if your insurer won’t pay, you might not know what to do when your roof damage claim is denied.
Though a denied claim is disappointing, it doesn’t mean you’re out of options. By acting quickly and strategically, you can appeal your claim and fight for fair compensation to cover repair costs. At Lawrence & Associates Accident and Injury Lawyers, LLC, we’re your partner in navigating the complicated insurance system to get the coverage you’ve already paid for. We’ll show you that denial isn’t the last word.
Understanding Why Your Claim Was Denied
The denial letter may provide several reasons why your claim was denied, including:
Cause of Damage
Your insurance company may say that the real reason for your roof damage was a lack of maintenance or that your damage falls under standard wear and tear.
They could also say that the damage was cosmetic, not structural. For roofs, that could mean a hailstorm damaged your shingles, but there are no holes in the roof and no damage to support beams, and your insurer could deny your hail damage claim.
Most homeowners insurance policies treat cosmetic damage differently and may only provide coverage if it exceeds your deductible. Your policy might also have a cosmetic damage endorsement clause, which lowers monthly premiums, but can allow the insurer to get out of paying for cosmetic damage altogether.
Policy Exclusions
Your denied roof claim letter may state your policy as written doesn’t cover your damage. They could claim that the damage came from an uncovered weather event, such as a flood, or that your roof has preexisting mold, rot, or pest damage. Your policy may also exclude certain roof materials, such as cedar shakes or metal roofs.
Most homeowners insurance policies also have a vacancy clause. This clause says your home is not covered if it is vacant for a certain number of days a year. Your insurance may say you weren’t living in your residence when the damage happened, so it’s not covered.
Insufficient Documentation
Insurance companies want to understand the extent of your damage, the cause of your damage, and how much it will cost to repair it. Make sure your documentation for the insurance company includes plenty of photos and a detailed estimate of the costs.
Missed Deadlines
Your homeowners insurance policy has a specific window for submitting roof damage claims. If you submit your claim outside that window, insurance will reject it.
Disagreement on Scope or Cost
Insurance will deny your claim if you submit an estimate below your deductible amount or that indicates repairs weren’t necessary. Make sure you are present when a contractor inspects your roof and read through any estimate before sending it to your insurance company.
Bear in mind that most homeowners policies, unlike other types of insurance, have the deductible amount set per claim, not per year. If you submit two claims in a year, you must pay your full deductible on both.
If you have a percentage deductible, it is based on the amount your home is insured for, not the amount of the damage. For example, if your home is insured for $100,000 and you have a three percent deductible, you are responsible for repair expenses up to $3,000.
Improper Filing
If there are errors in any part of your claim, your insurance company may deny it. Double-check everything you send to ensure it is correct and complete.
Review the Denial Letter and Your Insurance Policy
Once you’ve read your letter and understand your reason for denial, obtain a complete copy of your homeowners insurance policy. Read it thoroughly, paying close attention to sections regarding roof coverage.
Check out any coverage exclusions or conditions, especially if they involve the roof. Your policy may exclude damage from particular weather events and deny all wind damage claims, or it could have specific maintenance requirements you must meet to maintain coverage.
Take a look at your endorsements, too. Endorsements are minor changes to your insurance policy that either decrease or increase your coverage. Homeowners seeking lower premiums may add endorsements that take away coverage.
Actual Cash Value vs. Replacement Cost Value
Suppose you have a five-year-old roof that requires a full replacement due to tornado damage. If your policy provides for actual cash value, you’ll receive the replacement costs for a similar roof minus your deductible and depreciation. That means you’ll receive significantly less than the cost of the roof replacement.
If you have a policy for guaranteed replacement cost, you’ll receive the replacement costs for a similar roof minus your deductible. Many homeowners think they’re insured for guaranteed replacement cost on their roof, but are actually insured for actual cash value.
Gather Your Own Evidence
Gathering more evidence is vital to fighting your roof insurance claim dispute and winning. Try to collect:
- Fresh photos or videos of the damage to your roof
- Photos or videos of what your roof looked like before the damage
- Detailed estimates from contractors that specifically mention the cause of damage
- Proof of regular roof maintenance, such as a roof inspection prior to the damage
- Confirmation of severe weather impacting your area when the damage occurred
If you’re having trouble with evidence, a qualified property damage attorney may be able to assist you in assembling what you need.
Contact Your Insurance Adjuster or Company
After you’ve collected further evidence, get in touch with your adjuster or the insurance company. Ask for clarification on your reason for denial and present the evidence you have that contradicts their findings. You can show them your photos, estimate, or anything else you think refutes their denial.
Receiving an insurance denial can feel extremely unfair, but it’s important to keep your conversation polite and focused on the facts. Ultimately, you want your insurance company to agree to a re-inspection with your contractor present. Your roofer can speak face-to-face with the inspector and explain why they feel your policy covers the damage.
File a Formal Appeal With the Insurer
Most insurance companies have an internal appeals process allowing policyholders to object to denials. You may request an appeal through your company by sending a postal letter.
- State your policy number and claim number at the beginning of your letter.
- Reference your denial letter and the reasons given for denial.
- Politely explain why you refute the denial. Use specific language from your policy and mention the evidence you’ve gathered.
- Clearly state what you want, whether it’s to reopen your claim, reinspect your roof, or approve repairs.
- Send your letter by certified mail so you have proof that it was delivered to your insurance company.
If you don’t know how to appeal a denied insurance claim, you can get help from an experienced insurance lawyer.
Consider Getting a Professional
If you’re feeling overwhelmed by an insurance claim denial, there’s plenty of help available. Bringing a professional in can streamline the appeals process and reduce your stress.
Public Adjuster
A public adjuster is an insurance professional who works for you, not the insurance company. They can evaluate your roof damage, prepare estimates, and negotiate directly with the insurer on your behalf.
If you are dealing with extensive roof damage or a complicated claim, you may find it worthwhile to employ a public adjuster. You’ll typically pay a percentage of your insurance settlement as a fee, generally between five and 15 percent.
Attorney
You may wish to turn to a property damage lawyer, especially if you’ve already unsuccessfully appealed a denial. An insurance lawyer for a denied roof claim can be especially useful for large claims, cases that involve complex legal issues, or claims that insurers may have rejected in bad faith.
An initial consultation with an insurance lawyer is typically free of charge and doesn’t obligate you to take any action.
State Department of Insurance
If you feel your insurer is acting in bad faith or engaging in unethical behavior, you may wish to file a complaint with your state’s Department of Insurance. While they cannot force your insurance company to pay, they can examine whether your claim was handled properly.
Get Help With Your Roof Damage Claim from Lawrence & Associates
If you don’t know what to do when your roof damage claim is denied, contact one of our property damage attorneys. A no-fee, no-obligation consultation allows you to discuss your case, answer your questions, and learn about your legal options.
We have two decades of experience helping local homeowners navigate the complicated insurance system. Our clients know we pull out all the stops to help them. We get results.
At Lawrence & Associates Accident and Injury Lawyers, LLC, we understand the challenges you’re facing, and we’re here to protect your rights every step of the way. Our experienced Cincinnati & Northern Kentucky personal injury attorneys can guide you on what to do—and what to avoid—so you don’t unintentionally harm your case.
Call us today for a free, confidential consultation at (513) 951-6723 in Ohio and (859) 251-3045 in Kentucky, or fill out our online form to get started with a roof damage insurance appeal. Let us fight for the compensation you deserve.
