The Secret to Settling an Insurance Claim in Your Favor


I am often asked if there is a “secret” to settling an insurance claim in favor of a policyholder.  My response to that question is usually less than what was hoped for by the person asking it, for there is no such “secret” or magic formula.  Settling an insurance claim in favor of a policyholder is dependent upon only two things:  First, there must be a covered loss to the policyholder’s property and, second, the policyholder must prove that there is a covered loss to his property and what it will cost to restore that property to the condition it was before the loss.

That is all.  Nothing more than this or less than this will result in an insurance claim settled in your favor.  You must have a covered loss and you must prove you have a covered loss and the cost to cure it.

Your insurance policy is a contract between you and your insurance company.  Under that contract, you have a duty to prove that you have a covered loss and the cost to restore your property.  When you have proven your covered loss, your insurance provider has a duty to pay for your loss or prove that an exclusion exists in the contract that precludes their duty to pay it.

After a storm has passed through your area you might notice neighbors who are having new roofs installed, and some or all of them might have an insurance company paying for their new roof.  Not wanting to miss this opportunity, you might call your insurance company and ask them to send an adjuster out to see if you need a new roof, too.  While this telephone call will count as an insurance claim, it is likely to produce nothing more than a denial and a possible increase in annual premiums.  You are likely to think your insurance company is being unfair … but did you prove you had a covered loss, or did you simply rely upon your insurance company to do your work for you?

“I’ve had three roofing contractors tell me that my roof needs to be replaced,” you argue to the adjuster.  While it is likely that the roofing contractors were telling the truth about the need to replace the roof, it does not prove that there is damage or that, if there is damage, it is covered by the insurance policy.

There are certain damages and causes of damage that are not covered under an insurance policy.  For example, private and commercial buildings require regular maintenance and injury to the property resulting from deferred maintenance or accumulated wear or aging materials is not covered under an insurance policy.  Sometimes the cumulative effects of a ten-, fifteen-, or twenty-year history of storms can cause roofing materials to fail.  Attributing older damage to the recent storm will result in a denied claim.  What evidence did you provide to your insurance company to show that the damage you are reporting came from a single insured event that happened on the day you reported it to have happened?

“But my neighbors all have damage and are getting new roofs,” you argue to the adjuster. He hears this a lot, and he wonders how you would respond if the opposite were true and he were to tell you “I found storm damage to your roof, however, since none of your neighbors have damage, we cannot approve your claim.”  Your insurance claim has nothing at all to do with the conditions of property other than your own.

You might find a leak inside the home after a rainstorm and conclude from it that your roof was damaged.  This is not the time to file an insurance claim; rather, it is the time to call a qualified roofing contractor to inspect your property and tell you what the problem is, what caused it, and what it will cost to fix.  The cause may or may not be covered under your policy and the cost to repair may be less than the amount of your deductible, which are reasons why you should not file a claim.

If there is a “secret” to settling an insurance claim in your favor, that “secret” is to first prove to yourself – and then to your insurance provider – that you have a covered loss and what it will cost to restore your property to its condition prior to the event that damaged it.  If you need help doing this, call a licensed expert to assist you.



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