What to Do if the Insurance Company Denied Your Roof Claim

A damaged roof is expensive to repair. Most homeowners turn to insurance companies to cover the expenses of repairing or replacing the roof. But what should you do if insurance denied your roof claim?

When your roof claim has been denied, you need to consult with an insurance lawyer immediately. There are periods to be observed in appealing your case and failure to observe this period can result to an automatic denial of your claim. Should you need an insurance lawyer, you may call us at 212-233-1233 or send us an email at [email protected].

Denial of roof insurance claims

The insurance company’s most common reasons in denying a roof insurance claim are:

Age of roof

A roof’s useful life is usually around 20 years. If your roof is around 20 years old and has been damaged, your claim will likely be denied because the insurance company will argue that the damage to your roof was caused by ordinary wear and tear and aging, and not the covered peril that you are claiming for. On the other hand, you may be able to get some money from the insurance company for repairs but may not get the full replacement value of the roof.

Coverage Limits

Your insurance policy only covers damages up to a certain amount. In excess of this amount, the insurance company will not pay for it. In addition, there is a deductible where the insurance company will not pay for such amount of repair if it falls under the amount of deductible.

For example, your homeowner’s insurance policy covers damages up to the amount of $10,000. However, if the repair costs $500 or less (the deductible), the insurance company will not pay for it. For this reason, it is advisable to only file a claim that is over the amount of the deductible. If you file a claim for repair that is below the deductible, aside from the fact that it will be denied, you will also be subjected to an increase in premiums.

Not a covered peril

Your insurance policy covers certain disasters, while excluding others. Most common homeowner’s insurance policies include fire, lightning, theft, and smoke. Flood and earthquake are usually not included and will require the purchase of a separate additional insurance policy. Before making a claim, review your policy to ensure that your damage is covered. Filing claims with the insurance companies, whether or not these claims are denied, result to an increase in premiums.

Lack of roof maintenance

When you make a claim, the insurance company will send an adjuster to conduct a roof inspection. If this inspection shows that you have neglected to maintain your roof, such as failing to get roof leaks repaired, your claim may be denied. The insurance company can also argue that the damage was already existing before the occurrence of the covered peril (i.e., the rook was already in a state of disrepair before the fire occurred).

What to do after the insurance company denies your roof claim

Review your insurance policy for the period to appeal

As a general rule, you have six years to file a breach of contract claim, such as a claim against the insurance company for breach of the insurance policy. However, the insurance contract can limit this period, and courts will respect this time limitation, for as long as it is clearly stated in the insurance policy.

Usually, the insurance policy will provide a time period of two (2) years from the date of loss within which to file a lawsuit with the court. Loss will usually be defined in your insurance contract as the date when the covered peril occurred. If the word “loss” is not defined in the contract, New York courts have interpreted loss to begin from the time the insurance company denied your claim. Lobello v. N.Y. Cent. Mut. Fire Ins. Co., 151 A.D.3d 1206 (2017).

Denial beyond the period to file a lawsuit

What is your remedy when the insurance company denies your claim beyond the period stated in the insurance contract to file a lawsuit? For example, the covered peril, such as fire, damaged your roof on March 2017. The insurance policy stated you had two years from the time of loss (the fire) or until March 2019 to file a lawsuit against the insurance company for your claim. Your claim was $20,000 for the full replacement value of your roof but the insurance company only offered to pay $5,000 for repairs on April 2019, one month after the period to file a lawsuit expired. What is your remedy? In this case, you can argue that the insurance company engaged in a bad faith practice to intentionally delay the decision in your claim in order for you to lose your right to file a lawsuit.

To prevent this from happening, review your insurance policy and look for that period to file a lawsuit against the insurance company. When the period is nearing to expire without a decision from the insurance company, you should already file a lawsuit against the insurance company for your claim to ensure your rights are preserved. Consult with an insurance lawyer because most lawyers will accept a strong case for insurance claim on a contingency basis.

Review the denial decision of your claim.

A mere denial of your claim is not sufficient. The insurance company should provide a written denial, explaining the reasons for such. If the insurance company simply denied your claim without providing an explanation, you should demand for a written explanation. Once the insurance company provides you with the reasons for its denial, they cannot raise new reasons at a later time. This gives you protection from insurance companies because you have locked them in with their arguments.

Once you have the written explanation for the denial of your claim, compare the reasons given to your coverage in the insurance policy. If the insurance company cited a particular section in the insurance contract to support denial, review this provision. Maybe they are right. On the other hand, maybe there were provisions that you specifically asked the insurance company or your insurance broker that you would like to have, and they said it was covered in the insurance policy, but it wasn’t. If you have been misled by your insurance company or broker to believe you were covered when in fact you weren’t, you have cause of action against them – a bad faith insurance claim against the insurance company and a negligence claim against the insurance broker. American Bldg. Supply Corp. v. Petrocelli Group, 2010 N.Y. Slip Op. 30611 (N.Y.Misc 2010).

Improve the quality of the documents supporting your claim

After reviewing and analyzing the decision, check to see if you have more photos, videos, and other documents to support your claim. You should have pictures of your roof before the damage occurred to prove to the insurance company that the roof was in good state prior to the covered peril. If you diligently maintained your roof, present the receipts of your roof contractor to show that the roof has been well-maintained.

Get an estimate from a public adjuster.

Unlike the claims adjuster who is hired by the insurance company, a public adjuster can provide a more independent estimate of the property damage and the repairs needed to restore the property back to its original condition. Hiring a public adjuster will cost you anywhere between $200 to $500. The public adjuster’s report will give you another point of reference and comparison with the estimate of the insurance company. It is also another document that can support your claim for the full amount.

Call the insurance company to see if you can have your claim re-examined

If you and your insurance company have different interpretations of your insurance coverage, call them to request for a re-examination of your case. They may re-evaluate and decide that you are indeed entitled to your claim. If you believe that the contract language the insurance company relied on in denying your claim is ambiguous, you should point this out. When language in the insurance company is ambiguous, the courts would rule in favor of the consumer who did not participate in the writing of the insurance policy.

Consult with an insurance lawyer.

Before your time to file a lawsuit expires, it’s important that you already consult with an insurance lawyer about filing a lawsuit for breach of contract against the insurance company. Your lawyer might also be able to argue a bad faith insurance claim, which can allow you to get compensation for emotional distress, attorneys’ fees, punitive damages, and additional losses arising from the insurance company’s action.

When your claim is strong and supported by documents, most insurance lawyers will accept your case on contingency basis. You don’t have to pay for legal fees until the insurance company gives you a favorable settlement or you receive a favorable judgment award from the court.

Do not wait until the last minute to call an insurance lawyer. It takes time to evaluate a case and prepare a complaint. If your roof insurance claim has been denied and you do not know what to do, we at the Law Offices of Albert Goodwin are here for you. We have offices in New York City, Brooklyn, NY and Queens, NY. You can call us at 212-233-1233 or send us an email at [email protected].