How a roof damage claim actually works

This is a description of how claims generally work, not an opinion on yours. Your policy is the document that decides your claim, and your state insurance department is the authority on what your insurer is obliged to do.

In La Verne the failure that leads is the autumn offshore winds, which find anything already loose, and that shapes what a claim here usually looks like. These winds are not constant, which is the problem. A roof gets nine quiet months and then one night at fifty miles an hour, and whatever was marginal goes.

How a claim actually runs

A roof claim has a fixed shape. Something happens; you document it; you stop it getting worse; you report it; an adjuster inspects and writes a scope and an estimate; the insurer issues a first payment; the work is done; and if the policy pays replacement cost, a second payment follows once you prove the work was completed. Most of the trouble homeowners run into comes from doing those steps out of order — most commonly from letting a contractor start before anything has been documented.

The single most expensive mistake is tidying up before photographing. Once the tarp is on and the debris is cleared, the evidence of what happened is gone, and what is left is your word against an estimate.

Evidence, before anything else

Take four times as many pictures as feel necessary and make sure the dates are intact — most phones record this automatically, and it is worth checking rather than assuming. Include something for scale in the close shots. Photograph the gutters, the vent caps and the downspouts as well as the roof itself, because soft metal records an impact more legibly than a shingle does.

Alongside the photographs, keep a plain written note of what happened and when: the date and rough time of the storm, when you first noticed the damage, who you called and what they said. A dated contemporaneous note is worth a great deal more than a recollection three months later.

Worth having in one folder before the adjuster arrives:

• Your policy declarations page, showing the deductible and the settlement basis
• Dated photographs taken before anything was moved, cleared or covered
• Photographs of undamaged sections of the same roof, for comparison
• Interior photographs, including the attic and the underside of the deck
• Receipts for tarps, emergency call-outs and anything else spent making it safe
• The contractor’s written assessment, if you have had one done
• A dated written note of what happened, when, and who you spoke to

What the adjuster looks at

They will typically mark out a test square — often ten feet by ten feet — on each slope and count the impacts inside it, because a count per square is how the trade decides whether a slope is damaged enough to warrant replacing rather than repairing. They will check the gutters, the vents, the flashing, the ridge and the soft metal, and they will look at the slopes the weather did not reach as a control.

They are also assessing whether the roof was in serviceable condition beforehand. Missing shingles from an earlier storm that was never claimed, obvious prior patching, or a roof visibly at the end of its life all weaken a claim, because they make it harder to attribute the damage to one dated event.

Two settlement bases, and the difference is most of the cheque

There are two ways a policy can pay. Replacement cost value pays what it costs to put the roof back today. Actual cash value pays that same figure minus depreciation for the age and condition of the roof — and on a roof two-thirds of the way through its life, depreciation can be most of the money. Which one you have is written on your declarations page, and it is worth knowing before you file rather than after.

This one line in the policy is usually the difference between a claim that pays for a roof and a claim that pays for part of one. It is not negotiable after the fact; it is what you bought.

Mitigation: the step that is required of you

Policies place a duty on you to take reasonable steps to prevent further damage, and they generally reimburse the reasonable cost of doing so. A tarp, an emergency call-out, boarding a window, moving what is under the leak: these are expected of you, and failing to do them can reduce what is paid for the damage that followed.

The part that gets forgotten is the receipts. Emergency mitigation is normally recoverable and routinely goes unclaimed simply because nobody kept the paperwork for a tarp.

The deductible, and the thing no honest contractor will offer

The deductible comes off every claim payment, and many policies carry a second, larger one that applies only to wind and hail. That one is often written as a percentage of the insured value of the house rather than as a flat sum, which means it can be several times the size of the ordinary deductible. On a house insured for four hundred thousand dollars, a two per cent wind-and-hail deductible is eight thousand dollars, and a great many homeowners discover this at the worst possible moment.

Check the declarations page for both figures before filing. If the likely damage is smaller than the applicable deductible, filing achieves nothing and still puts a claim on your record.

What to find out first

Find out three numbers before you file: your deductible, your wind-and-hail deductible if you have a separate one, and whether the policy settles on replacement cost or actual cash value. Then get an independent written assessment of the damage. If the damage is plainly below the applicable deductible, filing gains you nothing and still records a claim.

Claims history affects renewal pricing and, in some markets, whether you are renewed at all. That is not a reason to avoid a legitimate claim on real damage — it is a reason to know the size of the damage before deciding.

What counts as fraud, plainly stated

It is worth being unromantic about why this matters to you specifically rather than in the abstract. A fraudulent claim can be denied and rescinded years later, the policy can be voided, the amount can be reclaimed, and the record follows you to every insurer afterwards. The contractor who proposed it has none of that exposure and has usually left the state.

If somebody suggests any of it, that is the end of the conversation with that company, and it is worth telling your insurer that the offer was made.

Why the argument is usually about how much of the roof

The word to know is "matching". If a repair would leave a visibly mismatched roof, some policies and some state regulations require a reasonably uniform appearance, which pushes the scope from a slope towards the whole roof. Whether that applies to you depends on your policy and your state, and it is a real question to raise rather than a trick.

Discontinued products come into it too. A shingle line that is no longer manufactured cannot be matched at any price, and that fact — evidenced, not asserted — often does more to move a scope than any argument about aesthetics.

Timelines, and the deadlines that bite

Report promptly even if you have not decided what to do about the damage, because the reporting deadline runs from the date of the loss and not from the date you noticed it. Reporting is not the same as committing to a claim, and you can withdraw one that turns out to be below your deductible.

There is also a limit on how long you have to sue if it comes to that, which in many states is considerably shorter for a property insurance policy than for an ordinary contract. If a claim is going badly, that limit is a reason to get proper advice early rather than to keep negotiating indefinitely.

If the claim is denied

The routes forward, roughly in order of cost. Ask for a re-inspection, with your contractor present and a written itemised scope in hand. Request the adjuster’s full report and photographs — you are generally entitled to the file on your own claim. Escalate internally to a supervisor or the insurer’s formal complaint process. Invoke appraisal if your policy contains an appraisal clause, which is a contractual dispute mechanism for disagreements about the amount rather than about coverage, and is usually far quicker and cheaper than litigation. File a complaint with your state insurance department. And, where the amount justifies it, take advice from a licensed public adjuster or an attorney.

A public adjuster works for you rather than the insurer and is licensed and regulated; they charge a percentage of the settlement. Whether that is worth it depends entirely on the size of the claim, and it is a decision to make with the numbers in front of you.

The short version

Document first, make it safe second, report third, and get the scope in writing before anybody starts work. In that order it usually goes smoothly. In any other order it usually does not.