Roof damage claims are among the most common and contentious adjustment experiences. A couple years ago, a video depicting a “Jeff” from State Farm went viral. In the video, a contractor reacts in disbelief as he directly displays the damage done to the roofing tiles on a State Farm policyholder’s home, only to have Jeff, the adjuster, deny that the damage is there or explain what the protocol should be for examining the roof in the first place.

Since it was posted in 2022, the video has garnered nearly a million views and over 8,000 comments on YouTube. Take a minute to read through the comments section, and you’ll find there are a number of former adjusters who explain that the field adjuster simply has to follow orders from claims management. One commenter writes:

I was a State Farm adjuster for 12 years, unlike many of the other adjusters I came from a roofing background, unfortunately Jeff is just the messenger, I would be put in these same positions where the decision has already been made by some d-bag sitting behind a desk that knows nothing about construction and it is nearly impossible to get them to change their mind. I was 100% on the customer’s side and willing to bat for them but could never get management to agree and change the decision they already made even with proper documentation and knowledge of roofing systems they would still deny them, then you get in trouble from middle management for wasting the upper management time. That is the reason I quit, I was tired of the big company making millions and ripping off the little guy and have me be the punching bag for them. 100% agree that roof is not repairable.”

How do I get my insurance company to replace my roof?

Insurance companies certainly don’t have to pay for the entire replacement of a roof just because the restoration contractor says so. However, they do have to honestly explain the true reasons for the disagreement and be able to support them.

To make the best case possible to your insurance company, it’s vital to keep good records about the condition of your home, particularly the roof. That means getting it professionally inspected to establish its condition ahead of time – before an incident that causes you to file a claim.

After the damage has been done, hire a reputable roofer to get an estimate on the damages. It may even be worth it to get a second opinion, simply to bolster your claim. When the adjuster comes to inspect your property, do everything you can to make sure that the adjuster reviews the roof thoroughly while you or your contractor explains the damage. As you can see from the video, it doesn’t always make a difference, but the better you can establish you’ve done your due diligence, the stronger the case you have against the insurance company if they deny your claim and you dispute.

What are some common reasons insurance companies deny roof claims?

Many insurance companies will deny roof claims for reasons related to the specifics of the policy, the nature of the damage, and how the damage was reported or documented. Here are some common reasons for denial:

  • Wear and Tear – An insurance company may claim that the damage to the roof was due to aging or lack of proper maintenance.
  • Roof Age – Insurance might only cover partial repairs or provide depreciated value for older roofs.
  • Improper Installation – If the insurance company alleges that the roof wasn’t installed correctly or used substandard materials, and this contributed to its damage, the claim might be denied.
  • Pre-existing Damage – Claims can be denied if the insurer determines the damage was pre-existing and not disclosed when the policy was purchased. Many big insurance companies don’t perform initial inspections when they issue a new policy, which makes it easier for them to allege that the damage to your roof may have pre-existed the start of the policy.
  • Insufficient Documentation – Lack of sufficient documentation or evidence of the damage and repair estimates can lead to claim denial. Insurers typically set a very high bar for documentation to make it easier for them to reject more claims.

What if an insurer denies my roof claim?

If an insurance company denies your roof claim, don’t panic. The key is to be persistent. Most insurers have an internal appeal process. Request detailed information about your insurance company’s appeals procedure and timeline. Once you’ve done that, gather more evidence for your appeal. A second roof inspection and additional photos or repair estimates can strengthen your case.

You might also want to consider hiring a public adjuster to advocate for you and assess the damage. You could also file a complaint with your state’s Department of Insurance if you feel the process was unfair.

How do I find an attorney for a dispute with my insurance company?

When you buy insurance, you do so with the expectation that that company will be there for you when you need them. Homeowners shouldn’t have to take their insurers to court just to get them to pay out for legitimate claims of loss. Unfortunately, though, scenarios like the one in the video above are becoming much more commonplace and a reason for the increase in lawsuits.

At Merlin Law Group, our attorneys have decades of experience defending policyholders from insurance companies that wrongfully deny claims or drag their feet making payments. Contact us to see how one of our attorneys can help you. And to learn more about how Merlin helps its clients, check out these resources:

Thought For The Day

The best time to repair the roof is when the sun is shining.
—Brad D. Smith