Roof Insurance Claim Denied? What to Check Next

A denial letter should say why the insurance company decided the way it did. If you only heard the decision by phone, ask for the denial in writing and keep every letter. The NAIC, the organization of state insurance regulators, gives the same advice for any denied part of a claim.

Read the letter for three things: the stated reason, the policy section or endorsement it quotes, and the facts it says it relied on, such as an inspection date or a report.

Each of those is the insurance company’s reading of your policy and the facts. Whether it is correct depends on your policy’s exact wording and on what actually happened to the roof, and this page doesn’t make that call. Then find the full policy section the letter quotes and read it in context, including any roof-specific endorsement or schedule listed on your declarations page.

Note any date in the letter, such as a time to respond, to send a signed proof of loss, or to complete repairs. For legal questions, including deadlines to file suit, talk with a licensed attorney.

The letter is a summary. The detail is usually in the insurance company’s file. You can ask in writing for copies of:

• the adjuster’s inspection report and the photos taken on the roof;
• any engineer’s or other outside inspection report the decision relied on;
• the insurance company’s estimate, if one was written;
• the full policy form and every endorsement the letter cites.

Send the request in a way that leaves a record, and keep a dated log of every call, email and letter. Whether the insurance company has to provide a particular document, and how quickly, depends on your policy and your state’s rules; your state’s insurance department can answer that question.

Good records help any later review of the decision, whoever makes it. Useful records on a roof claim include:

• dated photos of every roof slope and elevation, including any slope the insurance company’s adjuster did not walk (don’t climb onto the roof yourself);
• photos of gutters, downspouts, vents, screens and other soft metals;
• photos of any interior water stains, with dates;
• the date of loss and local weather records for that date;
• receipts for earlier roof maintenance or repairs;
• a written repair estimate that lists materials and quantities.

If the roof is leaking, check your policy’s duties-after-loss section and ask your insurance company what it expects for temporary repairs. The NAIC suggests taking photos or videos of the damaged areas and keeping all receipts for emergency repairs.

If you believe the adjuster missed damage, you can ask the insurance company to inspect the roof again. Put the request in writing, explain what you believe was missed, and attach your photos and estimate. Ask whether you, or someone representing you, can be present.

New documentation or a re-inspection may lead the insurance company to reconsider its position. It may also confirm the original decision. No particular result can be promised.

Some roof claims are not denied outright. The insurance company pays part and leaves other items out. A supplement is a written, itemized request for items that were omitted or undervalued in the insurance company’s estimate, with the documentation for each one attached.

The NAIC says differences in construction estimates are common and describes the aim as agreeing on a “scope of loss”: “a detailed list of the quantities of construction materials, labor, profit and overhead, building code compliance, and every single item required to repair or rebuild your home.” Whether any item is owed depends on your policy’s wording and the facts of the loss.

If your policy pays replacement cost, the first payment may be actual cash value, with depreciation held back until repairs are done. The NAIC calls the held-back amount recoverable depreciation, and notes there is usually a time limit to claim it, set by your policy and your state’s laws.

Many property policies include an appraisal provision. It is a process written into the policy for disagreements about the amount of a loss. The NAIC describes the process as beginning with two appraisers comparing their estimates and says: “The appraisal process only determines costs, not if your policy covers these costs. It isn’t a court proceeding.” It also notes that if you use appraisal, you’ll pay some of the costs.

Many appraisal clauses have each side name an appraiser and the two appraisers select an umpire. The exact terms, including who may ask for appraisal, what it can decide, its costs and any time limits, are in your policy’s wording and your state’s law. This page describes the provision; it doesn’t recommend for or against using it. For legal questions, including deadlines to file suit, talk with a licensed attorney.

If you have tried to resolve the issue with the insurance company and are still not satisfied, you can file a complaint with your state’s department of insurance. According to the NAIC, state departments look into issues such as unfair claim delays or denials, and the department forwards the complaint to the insurance company, which must respond with its explanation.

The NAIC suggests gathering your policy number and documents, keeping a record of all communication, sticking to facts and dates, using the policy’s own language where you can, and stating the outcome you are asking for. Most departments take complaints online, by mail or by phone. You can find your state’s department through the NAIC’s directory, linked in the sources below.

A complaint is separate from the claim itself. For legal questions, including deadlines to file suit, talk with a licensed attorney.

A public adjuster represents the policyholder, not the insurance company, on a first-party property claim: documenting the damage, preparing an estimate and presenting the claim. Questions about whether a loss is covered as a matter of law, or any other legal question, belong with a licensed attorney. We are not attorneys and do not give legal advice.

You are not required to hire a public adjuster. You can handle the claim directly with your insurance company. Public adjuster services carry a fee paid by the insured; see how public adjuster fees work. For denied and underpaid claims of every kind, see Denied & Underpaid Claims.

Licensing details are on our state pages. Resolution Claims Consulting, LLC is licensed as a public adjuster firm in Colorado, Illinois, Minnesota and Rhode Island. In Wisconsin, William J. Addis is a registered public adjuster (Registration #18667143). Associations can also see our HOA and condo hail pages for Colorado, Illinois and Minnesota.