If your insurance company denies your roof damage claim, there are several steps you can take:
Review the denial letter
Carefully review the denial letter from your insurance company to understand the reasons for the denial. It may provide information about specific areas of coverage that were not met or evidence that was lacking. Was the denial due to a cosmetic exclusion in your policy? Did you and or a trusted contractor review your policy together prior to filing the claim? If not, now’s the time to review your policy. You want to find out if you have an RCV (Replacement Cost Value) vs an ACV (Actual Cash Value) policy. They are treated night and day differently by your insurance carrier with regards to claims. Also, your deductible (co pay) as when and if it does come time to pay it, you’ll want to know how much you’re responsible for.
Gather additional evidence
If the denial letter indicates a lack of evidence, you can try to gather additional evidence to support your claim. Have a roofing contractor inspect the premises for legitimate damage. This also might include photos of the damage, formal request for reinspection, or a written report from an engineer. There are engineers that specialize in storm damage, keep this in mind when interviewing engineer firms prior to hiring one. It will likely cost thousands of dollars but when it comes to large loss claims, it’s a wise investment. Sadly, sometimes engineers are paid to sign off on denials to discourage policy holders from pushing the envelope. It happens more times than not. This is typically an indirect dynamic but easily proven in the industry.
What most building owners are completely unaware of is the fiduciary responsibility an adjuster has to the insurance carrier. Per your insurance policy, the burden of proving loss falls on you, the policyholder. The adjuster is paid to minimize responsibility of the carrier. Now, this isn’t to paint a malicious picture of intention in adjusters as many of them go out of their way to ensure the policy holder is aware of their contractual agreement & what the carrier owes them. It’s kind of like a police officer protecting citizen’s rights vs a cop who gets offended when someone knows the law. Both take place & it’s naive to think otherwise.
Hire a public adjuster
If you are not successful in negotiating with the insurance company, you can consider hiring a public adjuster to represent you. A public adjuster is a professional who specializes in negotiating with insurance companies on behalf of policyholders. They can help you gather additional evidence, negotiate with the insurance company, and, if necessary, pursue legal action. It’s becoming as common as getting an appraisal on a home to work with a public adjuster on a large loss claim. (Large loss is anything over $99,000 in estimated loss). Public adjusters typically charge on average 10% of the total claim and are named on the check. Once deducted from the net claim there are accurate funds to go towards the General Contractor facilitating the restoration. As a side note, ya lose it if you don’t use it when it comes to insurance work. Your best bet is to put every dime back into the property, restoring with like and kind back to new which maintains the value of the property. So, getting gangster by getting a dozen bids does you zero favors. Find a contractor who can successfully facilitate every aspect of the claim and get it done within the budget post public adjuster process.
File a complaint
If you believe that your insurance company is acting in bad faith by denying your claim, you can file a complaint with your state’s insurance commissioner. The insurance commissioner can investigate the matter and, if necessary, take legal action against the insurance company. I wouldn’t count on this for an outcome, but it can happen once in a blue moon that the carrier pivots. You’re better off having a public adjuster or attorney that comes recommended by a contractor who has tapped into this resource before.
It’s important to keep in mind that the insurance claims process can be complex and time-consuming. It may take several months to resolve a denied claim, even with the help of a public adjuster or legal action. If you have questions or concerns about the insurance claims process, it’s a good idea to consult with an attorney or contractor fluent in large loss insurance claims. If a contractor hasn’t facilitated claims worth six figures multiple times, that’s not a good fit and not yet the advocate you’re looking for.