Roofing Insurance Denial: Why Do Insurance Claims Get Denied and How To Get Approved

You already know that your roof is subject to all sorts of weather hazards on a daily basis, and it’s only a matter of time before it sustains damage.

So you’ve applied for expensive home insurance premiums to give us some peace of mind.

One of the most infuriating things that unfortunately still happens to homeowners today is getting caught off-guard by some hail or sudden storm that damages their roof, claim insurance and be denied by their chosen insurance company. Don’t let that happen to you.

Knowing what to do in situations of roof claim denial is the best way to protect ourselves from unjust denial.

Our professionals at K&M Roofing Services have compiled these common reasons for why home insurance claims are denied, and that you can watch out for these issues before they suddenly pop up.

We can also assist you in getting your insurance claim approved faster and with less stress, while potentially increasing the amount of your claim by thousands of dollars in repairs and replacements.

Why Do Insurance Companies Deny Roof Claims?

When it comes to your roof, most homeowner’s insurance policies only cover a limited number of reasons 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 do your homework and make sure you fully understand your policy before signing.

Your claim will most likely be denied for one of the following reasons:

Pre-existing Damage Prior To The Current Policy

It’s important to remember that damage from a previous policy will not be covered by your current coverage.

In most parts of the country, It’s doubtful that a storm will cause enough damage to merit a roof repair under a conventional home insurance policy in many parts of the country.

However, home insurance will only cover damage caused by the most recent occurrence, so if your roof system is failing due to a combination of old and new damage, your claim may be denied because the prior damage is the primary cause of the problem.

K&M Roofing Services can help you avoid this issue, as we offer free inspection of your roof prior to applying for your roofing insurance.

Partial Damage Can Invalidate Full Replacement Policies

The Insurance Adjuster must evaluate that enough damage has occurred to the roofing system that a partial repair would not return the roof to its prior state before approving a claim for a full roof replacement.

Unfortunately, the criteria for recognizing partial damage differs from one insurance company to the next, and it may ultimately be up to the Insurance Adjuster who inspects your roof.

When homes in your neighborhood are authorized for roof replacements, but your insurance company denies your claim, it can be one of the most stressful scenarios for homeowners following a disaster.

Partial damage is one of the most probable denials to be reversed because the assessment is arbitrary in nature.

Defective Roofing Materials

While manufacturers do their utmost to ensure quality control on their products, substandard materials do occasionally find their way onto your roof and degrade much sooner than they should.

Your home insurance company is not responsible for replacement costs if it is proven that a manufacturer flaw caused your roofing system to fail.

Almost all major roofing product manufacturers, however, include a standard limited warranty with the purchase of their products.

What that warranty covers is determined by the manufacturer and the warranty you choose.

Our professional roofers from K&M Roofing Services can inform you of warranties with additional coverage before installation.

Roof Has Gone Beyond Recommended Lifespan

Modern roofing materials endure longer and can handle more extreme weather, yet all materials degrade over time.

If you acquire a property with 30-year-old composite shingles that leaks after a few years, it’s likely that the shingles have simply outlived their usefulness.

This is especially true if the previous owner neglected to maintain the property.

Natural degradation is not covered by your house insurance policy, so if you’re buying a home with an older roof, be aware that it should be included into your budget or discussed with the homeowner prior to purchase.

Failure To File Claims On Time

Most homeowner’s insurance policies provide that a claim must be filed within a reasonable amount of time, and that damaged property must be replaced within a complete 365 days of the date of the incident.

If you fail to do so, or if you fail to tell your insurance carrier in writing before the 365-day period expires, along with a good cause for the delay and a request for an extension, your claim is likely to be denied.

Insurance inspections after suspected damage are frequently free, so avoiding a denial based on timeliness can often be as simple as scheduling an inspection and meeting with K&M’s roofing experts.

Damages Are Subject For Interpretation By Insurance Adjuster

It’s crucial to remember that an Insurance Adjuster is not a professional roofer or contractor, and their knowledge is frequently restricted to the training they receive from the insurance company when they perform a roof inspection.

Even the most well-intentioned Insurance Adjuster can overlook indicators of damage, resulting in your claim being approved due to ignorance.

This is why having your roofing contractor meet with your Insurance Adjuster on-site for the inspection is usually a smart idea, as we can point out damage and explain why it should be covered by insurance before it’s refused.

So How Can You Appeal For A Claim Denial?

If your initial claim is refused, there is an appraisal process that you as the insured can use to get the denial overturned.

It’s in your best advantage to do everything you can to avoid a refusal, such as having your contractor on-site for the inspection, because the appeals process can take a long time to complete.

If your claim is denied, you have a certain amount of time to appeal the decision, which you may find out by contacting your insurance company.

A written appeal should always be made. To shorten the length of the appeal procedure, you should request a resolution date in writing.

The insurance company will frequently send out another Insurance Adjuster for a second view after you submit an appeal.

We strongly advise having a skilled Roofing Contractor or even a Public Adjuster on-site at this time to serve as an unbiased 3rd party representation.

If you decide to use a Public Adjuster, keep in mind that you will be responsible for the costs, and the insurance company will not compensate you.

Evidence must be gathered to prove damage that requires approval under your present policy, whether you utilize a roofing contractor such as K&M Roofing Services or a public adjuster.

If the second Insurance Adjuster declines your claim, you’ll need to take your case to a Claims Manager.

You have two options as a last resort: submit a complaint with the state or employ an attorney.

The Importance of Knowing Roofing & Building Code

It is critical to hire an experienced Roofing Contractor not just to get your claim approved, but also to obtain the most value out of your claim.

Local and international building and roofing codes are changed throughout time, and if your insurance policy covers code coverage, these revisions may be covered.

These are especially useful for older homes, as code improvements can add thousands of dollars in defensive and energy-efficient features to your claim that aren’t already there.

International building and roofing codes are very technical and lengthy documents, and code improvements are likely to be overlooked unless they are thoroughly evaluated by a roofing contractor who is well-versed in local code requirements.

Furthermore, roof damage repairs aren’t limited to the exterior of your home.

When a leak happens, it can also cause damage to the interior of your home, and if the outside claim is granted, interior damage caused by a roof leak may be covered by your home insurance.

If a leak is suspected, a skilled Roofing Contractor will conduct a comprehensive check of the interior of your home as well, and will coordinate both the exterior and interior repairs.

Find A Reputable Roofing Contractor To Help Get Your Claim Approved

Knowledge is your most powerful weapon in avoiding an insurance claim denial, and an expert roofing contractor will have all of the tools and knowledge you need to get your claim approved.

Your insurance policy permits you to work with a contractor of your choice, so do your homework and find a reputable contractor who can help you through the entire process, from submitting a claim to final inspection, so you can get the most out of your house insurance policy.

K&M Roofing Services

K&M Roofing has been a pioneer in the Texas roofing sector since 1988.

We provide service throughout Dallas, Fort Worth, Austin, and the neighboring Texas areas.

Our roofing experts are ready to help you navigate the ins and outs of roofing insurance claims in order to get you the most out of your policy.