I will get at least one phone call this week, as I do every week, from someone who is upset with their insurance company for denying their claim for a “leaky roof”.  It usually goes something like this: “My contractor told me my roof must be replaced.  There is hail damage to it, but my insurance company refuses to pay for it.  I need your help.”   Before they call me – actually, before they call their insurance company and file a claim – there are things they should know.

     The first thing an insured home or business property owner should know is their duty to prove their loss when they file an insurance claim.  Simply reporting damage to their insurance company does not fulfil their duty under the insurance contract to prove they have a covered loss.  Most policyholders are unaware that they have this burden of proof and will merely report damage to their insurance provider and then leave it to the insurance company and their adjuster to prove their claim for them. 

     As one can reasonably expect the effort to prove the policyholder’s claim is not always accomplished to the satisfaction of the insured policyholder, when expecting their insurance company to be zealous in proving that the policyholder is entitled to money.  Instead, they find that the insurance company has sent their adjuster to the damaged property primarily to fulfil their duty under the insurance agreement – the duty they have to prove that an exclusion to coverage under the policy exists and payment should be denied.

     The contractor may have told the policyholder the truth.  The roof might need replacement and there might be hail damage present.  Neither of these two facts, however, sufficiently prove that the loss is covered under the insurance policy.  

     Before filing the claim, the prudent insured property owner will first determine the following:

     1. When did the hail damage occur?  A shingled roof can last twenty to thirty years and, over its lifetime, will be struck by many hailstorms and can be insured over that same period by many different insurance companies.  Which hailstorm is being reported to be the one that caused the damage and what company insured the roof on that date?

     2. How significant is the hail damage?  Roofs will age and incur damage from normal wear and tear, a condition that is excluded under the insurance policy.  Is the hail damage to the roof significant enough by itself to warrant a replacement, or are there only a few selected shingles damaged by hail and the rest of the roof needs replacement for other natural (and non-insurable) reasons?  

     3. Is there evidence of hail damage to exterior surfaces other than the shingles?  While resilient composite shingles are designed to deflect hail strikes to minimize damage, other surfaces are not.  Damaged shingles should also be surrounded by other evidence of hail strikes to soft metals such as appurtenances, gutters, downspouts, fascia, mailboxes, HVAC units, patio furniture, wood deck surfaces, lawn furniture and other surfaces struck by the same hailstorm.  Not only can this additional damage be included as part of the claim, but it will also serve as proof of the severity and (sometimes) the date of the storm. 

     These are a few of the things that one must consider when proving their coverage for a loss to a roof due to hail damage.  There are more, and a good roofing contractor can assist a policyholder in compiling evidence to provide to the insurance carrier that the damage is covered under their insurance policy. 

     Needing a new roof and having a valid insurance claim for damage to an existing roof are not the same thing.  Policyholders who file insurance claims have the duty to prove their covered loss.  The best time to prove it is to themselves before they file the claim so that they may, in turn, prove it to their insurance company when the adjuster arrives.

To prove a covered loss in the manner required for a successful insurance claim is not always easy to do.  When in doubt, consult with a licensed public adjuster.  Don’t get mad … get paid.