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Imagine your roof gets struck by hail, is torn apart by high winds, or suffers a blow from a falling tree. It isn’t fun to think about, but it’s good to be prepared in case it ever happens.

That’s why you pay for insurance — you hope you never have to use it, but you want to have it just in case. While having insurance is far less stressful than paying for a new roof out of pocket, sometimes filing a claim can feel overwhelming. Sometimes it feels like you have to jump through a lot of hoops to get the money you need to fix your roof.

Luckily, the insurance process for repairing or replacing a damaged roof doesn’t have to be intimidating or exhausting. Once you understand how it works, it isn’t as hard as it first appears. Let’s walk through everything you need to know so you’re ready when the day comes that you need to make that call.

Reasons you might file a claim: signs of damage

If you suspect your roof may be damaged, you can inspect your property yourself to get an idea of the condition. But before you get up on a ladder, start by examining things from the ground. If a recent storm has damaged other parts of your property (cars, mailboxes, trees, windows, etc.), chances are that your roof is in similar condition.

If there is damage evident, it might be time to file a claim with your insurance company. Typically your homeowner’s insurance policy will cover damages that occur suddenly or happen due to unpreventable circumstances. These include things like:

  • Hail damageHail damage may appear minor in photographs, but it shouldn’t be ignored. On an asphalt roof, hail damage often appears as a series of dark spots or dents. But these damage spots often go much deeper than they appear. Continued exposure on spots with missing granules can quickly wear a hole into your roof and cause major leaks.
  • Wind and vortex damage – High winds and even the vortex created from a low-flying plane can rip shingles right off your roof. Otherwise, minor wind damage may cause your shingles to bend at the corners or edges. Occasionally your policy may cover wind damage from tornadoes or hurricanes, but it depends on what area of the country you live in.
  • Impact damage – Holes are an obvious sign that something has impacted your roof. In more severe cases, a fallen tree can cause your whole roof to cave in. But even if the damage isn’t drastic, impact damage from small branches or even vandalism may knock granules loose from the shingle and expose the material to deterioration from water and UV rays.

Types of insurance coverage for roofs

Most often if a roof is damaged, you’ll use your homeowner’s insurance to cover the repairs. But depending on what caused the damage and what your policy covers for your area, you may need to use another type of insurance.

That said, a large portion of roof damage claims (40%) are the direct result of either wind or hail damage. Because of this, insurance companies created wind/hail damage as a specific category of coverage to prevent losing too much money on these claims. There are likely other types of roof coverage outlined in your policy, but wind/hail coverage is the most common.

Within this category, insurance policies typically offer three types of coverage:

  • Repair coverage
  • ACV coverage
  • Replacement coverage

It’s also important to note that each type of coverage will require you to pay a deductible before you receive a payout. A deductible is the amount you (the homeowner) are responsible for paying. This amount is usually deducted from the amount your insurance pays out for the project. So if you’re covered for $10,000 and you have a $1,000 deductible, your insurance will likely only give you $9,000.

Repair coverage

Repair coverage is exactly like it sounds. After you pay your deductible, it only covers the cost of repairs. If your home has only minor damages, this may be all you need to fix the issue and bring your roof back up to code. If your roof needs a full replacement, you still might get some money. However, it likely won’t be enough to cover the whole project.

ACV coverage

Actual Cash Value (ACV) coverage is a form of replacement coverage, but with one major restriction. With ACV coverage, the money you receive for a replacement project is adjusted based on the age and current market value of your roof.

For example, let’s say your roof replacement job is going to cost $10,000. If you have a $1,000 deductible, you will still pay that amount. But let’s say your insurance company values your roof at only $7,000 due to its age. This means you’ll pay a total of $3,000 (your deductible + the remaining cost of the project) out of pocket to complete the job.

While ACV coverage does help with some of the cost, having this policy isn’t the ideal solution for every home (especially if your roof is older).

Replacement coverage

Replacement coverage is the most ideal type of wind and hail protection to have. With this coverage, your insurance company will pay the full amount to replace your roof (aside from your deductible).

For example, let’s say your roofing project costs $10,000. If your deductible is $1,000, that’s all you pay. Your insurance company should send you a check for the remaining $9,000 to pay for the project.

What isn’t covered?

While every policy is different in what it covers, there are certain scenarios that aren’t covered by most insurance policies. Read through your policy and check with local legislation to be sure about your situation. Here are a few things that are usually excluded:

  • Normal wear and tear – Every roof is bound to need a replacement eventually. However, most insurance policies are only meant to cover sudden, unexpected events. If your roof is simply reaching the end of its life, your insurance probably won’t cover a replacement on those grounds. Beyond that, the prior wear and tear may cause the insurance company to deny your claim even if something suddenly damages your roof.
  • Hurricanes – In Florida and other coastal states where tropical storms occur frequently, homeowner’s insurance often doesn’t cover hurricane damage. Instead, most of these states have set up “Hurricane Coverage” as a separate category of insurance.
  • Fires – Fire damage is typically covered under fire insurance, which is a totally different type of coverage within your policy. It may even be a separate type of insurance depending on where you live.
  • Intentional damage – If you intentionally cause damage to your roof or other parts of your home, your insurance will not cover that. This can even include accidents that occur during DIY repairs. So if you end up destroying part of your roof by accident because you weren’t being careful, you may have to pay for a repair or replacement yourself.
  • Poor maintenance – Similarly, if something happens because you don’t take proper care of your roof, your insurance probably won’t cover that damage either. So be sure to clean your gutters, replace shingles when necessary, and work to prevent ice dams during the winter.

The complete insurance claim / repair process in 10 steps

Now that you understand the types of coverage you may have, let’s walk through the process step by step so you know what to expect.

1. The damage occurs

If a storm comes through and you suspect your roof was damaged, take a look around your roof from the ground level. If you can safely climb up onto a ladder, you can do a preliminary inspection of the roof yourself. Depending on the issues, you may realize it’s unsafe to remain in your home until repairs are complete. If this is the case, it’s best to move your family to another location such as a hotel or a friend’s house while you follow the rest of these steps. In extreme cases, you may need to call emergency services to make sure the situation is controlled safely.

2. Get a roof inspection from a trusted roofer

While a tree lying over the middle of your roof is easy to notice, other types of damage may not be. No matter what you find in your initial inspection, calling a professional roofing company to inspect your roof is essential. By hiring a trusted roofer, you can understand the damage from someone with a trained eye. They should also provide you with further guidance about whether you need to replace your roof or simply repair it. In some cases, your chosen roofing company may be able to handle the entire insurance claim process for you.

3. Know your coverage

Before you agree to sign anything, be sure to review your policy to know what kind of damage it covers. Either way, you’ll most likely want to use your insurance to cover at least some of the costs. However, it’s good to know what kind of payout you’re most likely to receive from the insurance company so you can prepare. You may need to read through additional parts of your policy if your roof is affected by something other than wind or hail. If you need help understanding your policy, you may decide to call your insurance company for help. Otherwise, if your chosen roofer offers insurance claim services, you may ask them to help you understand your coverage.

4. File a claim with your insurance company

Once you know the scope of the roofing project and what type of coverage you’re working with, it’s time to call the insurance company.

Tell them that you want to file a claim and describe the type of damage and the scope of the replacement scenario. At this stage, it’s wise to inform your insurance agent that you’ve already hired a roofing company to do an inspection and assist with the insurance process if that’s the case. The insurance company will then schedule an appointment (usually within 72 hours) for an adjuster to inspect your roof as well.

If your insurance company asks you to get multiple estimates from different roofing companies, be aware that you don’t have to do that. While they may be adamant about it, they can’t require you to get multiple bids. Most often, insurance companies will end up approving the cheapest option because it helps their bottom line.

Instead, focus on choosing a roofing company that does the best quality work. A roofer that charges more for a high-quality roofing job will provide your home with more value over all. Your insurance adjuster will need to work with the roofer to accept liability for the project. In other words, your policy should allow you to choose the best contractor, not just what your insurance company “allows.” They are responsible for paying out the amount necessary to fix your roof according to what’s in your policy.

5. The adjuster inspection

When the insurance adjuster arrives, they will do a roof inspection just like the roofing company. However, their goal is to adjust the scope and price of the initial inspection according to their own assessment.

Be aware that insurance adjusters and roofing contractors often disagree because they have different interests. While the insurance company is trying to save money, the roofing company wants to make sure they can do the job correctly — which often means charging more money for things like bringing the roof up to code, high-quality materials, and safety equipment.

With that in mind, don’t always take the insurance adjuster’s opinion about the situation as pure fact. Insurance companies train their employees and spend billions of dollars on public relations to persuade people to believe their claim options are limited. This ultimately lowers the amount they have to pay out because many homeowners simply trust whatever they say. That’s why it’s important to know your policy and hold your insurance company accountable for what they agreed to in writing.

After some debating and negotiating, your insurance company should finally agree on the scope of the project and the amount they will pay out.

6. Pay your deductible

Before the job begins, you’ll need to pay your deductible directly to the roofing company. Remember, this is the portion of the cost of the project that you (the homeowner) are responsible for paying. Often, the insurance company will rely on you to pay the deductible on your own and send you a check for the rest. However, they may want proof that you paid it before sending you the first check.

Be aware that some roofing contractors will offer to waive your deductible as a way of sweetening the deal. But if this is part of their offer, they probably aren’t a legitimate business. Not only is this a form of insurance fraud, but the fact that a roofer is willing to cut corners in this area means they will probably cut corners with your roofing job as well. Contractors who try to win your business by offering the lowest bid are often making up for that cost by using lower-quality materials or unqualified workers. They may also try to complete the repairs without a building permit, which can cause problems in the long run if the job doesn’t go well.

7. Receive your first check

Once you pay your deductible, your insurance company will send you an initial check to pay for the job. You’ll usually use this check (along with the deductible) to put a down payment on the project or pay for it all up front. If you have ACV coverage, you will probably only receive one check. The rest will be your responsibility. If you have replacement coverage, you will most likely get the other part of the payout after the job is complete.

8. Complete the roofing job

After all these steps, it’s time to schedule the job with the roofing company of your choice. They will then come to your home and repair or replace your roof according to the scope you agreed on.

However, be mindful that once the roofer starts the job, they may find issues that weren’t clear in the inspection. For example, they may start tearing off the old shingles and realize the plywood decking underneath is bad. They’ll need to replace that to make sure your roof doesn’t fall apart in a few years. Other times, you may decide to replace your gutters or skylights if they were damaged due to the same event.

If your roof requires these additional repairs, you will want to reach back out to your insurance company to discuss the changes. Either way, be sure to send them a copy of the invoice once the project is complete. The final cost may be higher than the initial estimate.

9. Receive your final check

At this stage, your insurance company should send you a second check to cover the rest of the job. You’ll then give this to the roofing company to finish paying for the project.

If by some chance the insurance company gave you more money for that specific project, than necessary, don’t use the extra money to pay for anything else. That’s considered insurance fraud. To mitigate this risk, some insurance companies may ask you to send them the invoice so they can pay the roofing company directly. This also creates less work for the homeowner and puts the responsibility of settling the claim in the company’s hands.

Remember: if you only have ACV coverage, you probably won’t get a second check. If the remaining amount of the job is too much to pay out of pocket, you may consider financing the rest of what you owe.

10. Provide documentation—and relax!

After the job is done, most insurance companies request proof that the job was completed according to scope. Be sure to send your insurance company any official documentation or proof that they request.

Now that your roof is replaced and the insurance process is complete, you can rest easy under your new roof.

Common claim denials and how to oppose them

Once you know how the insurance process works, it’s much easier to handle. But not everything always goes according to plan. Sometimes, insurance claims get denied for a variety of reasons.

4 reasons your claim might be denied

  • Pre-existing damage – If the damage to your roof was already there before the sudden event (e.g. a hail storm or a fallen tree), it isn’t eligible for an insurance claim. Otherwise, if the insurance company believes the damage is pre-existing, they may deny your claim on those grounds.
  • Negligence – If your roof was damaged due to improper maintenance, this is also a reason for insurance companies to deny your claim. Proper maintenance means cleaning your gutters, ensuring proper roof ventilation, and repairing shingles when they get damaged. However, it also means trimming or cutting down dead trees before they fall and damage property. Negligence may also include damage that occurred due to improper safety measures.
  • Poor installation – Let’s say your roof falls apart just a few years after it was installed. In many cases, this happens because the previous roofing contractor installed the roof incorrectly. While this is unfortunate, this is a common reason insurance companies will deny your claim. That’s one of the reasons it’s so important to hire a local established roofing company with a reputation for quality workmanship.
  • The adjuster and the roofer disagree – While the insurance adjuster almost always disagrees with the roofer on a few things, sometimes the disagreements are vast. Most of the time, they may have an honest disagreement. Other times, the insurance company may be acting in bad faith by completely denying the truth about the damage (usually so they can save money).

How to oppose a claim denial

Even if your claim gets denied or your insurance adjuster and the roofer don’t agree on scope or price, you still have plenty of room to negotiate. The main thing to remember is this: as long as you’re within the statute of limitations for your policy, a claim isn’t closed until a settlement is reached.

Insurance companies may seem too powerful to disagree with, but they still have rules to follow. Here are a few things you can do to get past a claim denial:

  • Appeal it (multiple times) – The first thing you can do if your claim is denied is start an appeal. This means going directly to the insurance company and filing a formal request to reconsider the claim. They may schedule another adjuster inspection or take a look at the existing paperwork again. You’ll likely have to state your case and go through a complex process, but it may work out in your favor. Most insurance companies allow you to appeal your claim 2-3 times in total before they give a final verdict.
  • Hire a public adjuster – A public adjuster doesn’t work for a private insurance company. Instead, they work on behalf of homeowners to negotiate and settle insurance claims. While they do cost extra money to hire, they can often be very helpful in settling a disagreement between the roofer and your insurance company.
  • Hire a third party structural engineer – If your insurance company denies your claim on the grounds that there isn’t any damage to your roof, a structural engineer can help. Structural engineers inspect homes and other buildings to see if there is any damage that could be fatal to certain parts of the structure. While this person may be expensive to hire, you can use their inspection report as scientific evidence that your roof is truly damaged. This will come in handy if you decide to start an appeal.
  • Sue the insurance company – If you believe your insurance company is acting in bad faith regarding a claim, and you have already tried to appeal it, you can sue them. But lawsuits are almost always a huge hassle — you should only take this route if you’ve tried everything else and they still deny your claim. However, if your roof is in dire need of a replacement, a lawsuit may be necessary to complete the job.
  • Let your roofing company fight for you – Some roofing companies will handle the entire insurance and replacement process on your behalf. While it may cost a little more, it’s often worth it to have a seamless experience of working directly with your roofer. They may even go to bat for you if the insurance company denies your claim.

Final thoughts

If you’re currently stressed out from dealing with roof damage — don’t worry. You’re not the only one. In order to get the insurance payout you need to replace your roof, it will take careful thought and persistence. However, you don’t have to do it alone.

Not many people are experts when it comes to insurance claims. Fewer people are experts in roofing. Luckily, we at Baltic Roofing are experts in both. We work with hundreds of different insurance companies every year to make sure homeowners get the job completed the way it needs to be done.

To avoid potential disagreements with the first roof inspection, you can call us first before you even file a claim. We’ll inspect your roof for damage and let you know the true condition. You may not even have to file a claim at all.

If you do have to file a claim, we’ll be available to support you throughout the process. When the adjuster shows up at your home to inspect the roof, we’ll meet them there to ensure the inspection is complete and accurate. Then, when it’s time to replace your roof, you can count on receiving quality work. We practice our craft in our office — not on your home.

Filing a claim for a damaged roof doesn’t have to give you a headache. Invest in a new roof you can trust to last for many years to come.

Contact us for a roof inspection and help with your insurance claim today.

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