Roof Insurance Claim Denied? What South Carolina Homeowners Should Do Next

Insurance companies deny roof claims for specific, documented reasons. Understanding why your claim was denied is the first step toward a successful appeal. Here are the most common denial reasons for South Carolina homeowners, particularly along the Grand Strand coast.

Age and Wear and Tear

The most common denial reason. Your insurer argues that the damage is the result of normal aging rather than a specific covered event like a storm. This is particularly common for roofs over 15 years old in coastal SC, where salt air, UV exposure, and humidity accelerate shingle degradation. The problem: many adjusters attribute legitimate storm damage to age because the roof already showed signs of wear. Storm damage on an older roof is still storm damage -- your roof does not have to be new for a covered peril to cause covered damage.

Lack of Maintenance

Insurers argue that the homeowner failed to maintain the roof, and the resulting deterioration caused or contributed to the damage. In coastal South Carolina, this often involves claims about moss growth, clogged gutters, or missing shingles that were not repaired before the storm. Homeowners policies do require reasonable maintenance, but insurers sometimes use minor maintenance issues to deny claims for clearly storm-related damage. The question is whether the maintenance issue caused the damage or simply existed alongside it.

Cosmetic vs. Structural Damage

Some insurers -- and some SC policies -- distinguish between cosmetic damage and functional or structural damage. Hail dents on metal flashing, granule loss on shingles, or cracked but not broken tiles may be classified as "cosmetic" and excluded from coverage. The challenge: damage that appears cosmetic today can become structural tomorrow. Granule loss exposes the asphalt mat to UV degradation, significantly shortening the roof's remaining life. Many denied claims fall into this gray area.

Pre-existing Damage

The adjuster claims the damage existed before the storm event you filed the claim for. This is common when homeowners do not have before-and-after documentation. Without dated photos of your roof in good condition before the storm, the insurer can argue that any damage they find was already there. This is one reason why regular roof inspections with documentation are critical for SC homeowners.

Filing Deadline Missed

Most SC homeowners policies require you to report damage "promptly" and file a formal claim within a specific window -- often 60 to 90 days after the event, though this varies by policy. After major hurricanes, many homeowners are dealing with so many problems that the roof claim gets delayed. If you miss the filing deadline, the insurer has a contractual basis for denial regardless of the legitimacy of your damage.

Excluded Peril

Your policy may not cover the specific event that caused the damage. Standard homeowners policies in SC typically exclude flood damage (requires separate NFIP or private flood policy), earthquake damage, and sometimes windstorm damage in coastal counties. If you live in Horry, Georgetown, or Brunswick counties, verify that your policy explicitly covers wind and hurricane damage -- some coastal policies exclude it or require separate wind/hail deductibles.

Before you start the appeal process, you need to understand exactly what your policy says. Most homeowners have never read their full policy. After a denial, reading it is no longer optional -- it is your most important tool.

Actual Cash Value (ACV) vs. Replacement Cost Value (RCV)

This distinction determines how much you receive even if the claim is approved. Replacement Cost Value (RCV) pays to replace your roof with equivalent new materials, regardless of age. Actual Cash Value (ACV) pays replacement cost minus depreciation based on the roof's age. A 20-year-old roof with an ACV policy might receive only 20-30% of the replacement cost. Many SC homeowners do not realize their policy switched from RCV to ACV when the roof reached a certain age (often 10 or 15 years). Check your declarations page for the current valuation method. For more details, see our guide to insurance coverage for older roofs in SC.

Covered Perils

SC homeowners policies are typically "open peril" (covering everything unless specifically excluded) or "named peril" (covering only events listed in the policy). Most standard policies cover wind, hail, fire, falling objects, and the weight of ice or snow. They typically exclude flood, earthquake, neglect, and intentional damage. Your denial letter should reference the specific policy language justifying the denial -- if it does not, request it in writing.

Deductible Structure

Coastal SC policies often have a separate, higher deductible for hurricane or named storm damage -- often 2% to 5% of the home's insured value rather than a flat dollar amount. On a home insured for $300,000, a 2% hurricane deductible is $6,000. If the estimated damage is close to or below the deductible, the insurer may deny the claim because the damage does not exceed the deductible threshold. Make sure you know which deductible applies to your specific event.

Exclusions and Endorsements

Beyond standard exclusions, your policy may have endorsements (add-ons) that modify coverage. Common SC-specific endorsements include cosmetic damage exclusions for hail, limited water damage coverage, and roof material restrictions. Read every endorsement. Some denials are based on endorsement language that the homeowner did not realize was added to their policy at renewal.

A denied claim is the insurer's first answer, not the final one. This step-by-step process is specific to South Carolina homeowners and incorporates SC insurance law, coastal damage considerations, and the SC Department of Insurance complaint process.

Step 1: Read the Denial Letter Carefully

The denial letter must specify the exact reason for the denial and reference the policy language that supports it. Read every word. Common denial language includes "failure to maintain," "wear and tear consistent with age," "cosmetic damage only," or "damage predates the reported event." Write down the specific reason and the policy section cited. If the letter is vague or does not cite specific policy language, that is itself a problem -- SC Code Section 38-59-20(1) requires insurers to communicate claim decisions clearly and promptly.

Step 2: Request the Full Claims File

Under South Carolina law, you have the right to request your complete claims file. This includes the adjuster's field notes, all photographs the adjuster took, the adjuster's estimate (even if they did not share it), any internal communications about your claim, and the supervisor's review notes. Submit your request in writing (email is fine but follow up with a certified letter). The claims file often reveals information the denial letter omitted -- sometimes the adjuster's own notes contradict the denial reason.

Step 3: Get an Independent Roof Inspection

This is the most important step. Hire a licensed, insured roofing contractor to perform a thorough independent inspection and produce a written report with photographs. The inspector should document every instance of storm damage they find, differentiate between storm damage and pre-existing wear, note damage patterns consistent with the specific weather event (wind direction, hail size), inspect the attic and interior for water intrusion, and produce a detailed repair or replacement estimate.

The independent inspection report directly counters the adjuster's findings. If the adjuster said "wear and tear" and your independent inspector documents a clear hail impact pattern consistent with the storm date, you have a factual basis for appeal.

Step 4: Gather Supporting Documentation

Build a documentation package that supports your appeal:

• Weather data: NOAA storm reports, hail maps, and wind speed data for your specific location on the date of the event. The National Weather Service in Wilmington, NC covers the Myrtle Beach area and maintains detailed storm records.
• Before photos: Any photos of your roof before the storm -- Google Street View historical imagery, real estate listing photos, or prior inspection photos all work.
• After photos: Date-stamped photos taken immediately after the storm, showing the damage from multiple angles.
• Contractor estimates: Two or three repair or replacement estimates from licensed SC contractors.
• Prior inspection reports: If you had a roof inspection before the storm showing the roof in good condition, this directly counters "pre-existing damage" claims.
• Neighbor claims: If neighbors on your street had claims approved for the same storm event, that establishes the storm caused damage in your area.

Step 5: Write a Formal Appeal Letter

Your appeal letter should be professional, factual, and specific. Address the exact denial reason cited in the letter and counter it with evidence. Include:

• Your policy number and claim number
• The date of the original claim and the date of denial
• The specific denial reason from the letter
• Your factual rebuttal, referencing attached documentation
• The independent inspection report and estimate
• Weather data proving a covered event occurred
• A clear statement of what you are requesting (claim approval and payment)
• A deadline for response (30 days is reasonable)

Send the appeal by certified mail with return receipt requested and keep a copy. Also send it by email if you have an email address for the claims department. SC law requires insurers to acknowledge receipt of communications promptly -- if they do not respond within a reasonable time, that becomes evidence for a bad faith complaint.

Step 6: Invoke the SC Appraisal Clause

If the insurer denies your appeal or responds with an offer you believe is unfair, check your policy for an appraisal clause. Most SC homeowners policies include one. The appraisal process allows each side to hire an independent appraiser. The two appraisers select a neutral umpire. If the appraisers cannot agree, the umpire makes a binding decision on the amount of damage. This process resolves disputes about the amount of damage, not whether the damage is covered. We cover this in detail in the next section.

Step 7: File a Complaint with the SC Department of Insurance

If your insurer has not responded to your appeal, has acted in bad faith, or has not followed proper SC claims procedures, file a formal complaint with the South Carolina Department of Insurance (SC DOI). You can file online at doi.sc.gov or by mail. The SC DOI investigates complaints and can take action against insurers who violate SC insurance regulations. Filing a DOI complaint puts the insurer on notice that a regulatory body is now watching how they handle your claim -- this alone often prompts a more serious review.

South Carolina has some of the strongest bad faith insurance protections in the Southeast. If your insurer denied your roof claim without proper justification, these laws may apply to your situation.

SC Code Section 38-59-20: Unfair Claim Settlement Practices

This statute defines specific practices that are illegal for insurance companies operating in South Carolina. Relevant provisions for denied roof claims include:

• Misrepresenting policy provisions: Telling you something is not covered when it actually is
• Failing to acknowledge communications promptly: Ignoring your appeal or failing to respond within a reasonable time
• Failing to adopt reasonable standards for investigation: Denying a claim without conducting a thorough investigation
• Not attempting to settle claims fairly: When the insurer's liability is reasonably clear
• Compelling policyholders to file lawsuits: By offering substantially less than the amount due
• Denying claims without conducting reasonable investigation: A rubber-stamp denial without meaningful review

SC Code Section 38-59-40: Penalties and Remedies

When an insurer commits bad faith in South Carolina, the homeowner may be entitled to actual damages (the amount the claim should have been paid), consequential damages (additional costs caused by the denial, such as emergency repairs paid out of pocket or additional property damage from delayed repairs), attorney fees, and in some cases, punitive damages if the insurer's conduct was particularly egregious. The availability of attorney fees is significant -- it means that pursuing a bad faith claim does not necessarily require large upfront legal costs, because the insurer may be ordered to pay your attorney fees if you prevail.

When Bad Faith Applies to Denied Roof Claims

Not every denial is bad faith. Insurance companies have the right to investigate claims and deny those that are not covered. Bad faith applies when the denial is unreasonable under the circumstances. Examples that may constitute bad faith in SC:

• Denying a claim based on "wear and tear" when the adjuster's own photos show clear hail impact patterns
• Denying a claim without ever sending an adjuster to inspect the roof in person
• Denying a claim based on "pre-existing damage" without any evidence that the damage predates the reported event
• Failing to respond to a properly submitted appeal within a reasonable time
• Denying a claim when neighbors with the same insurer had similar claims approved for the same storm
• Using a desk adjuster and satellite photos instead of conducting an in-person inspection for a contested claim

The appraisal clause is one of the most powerful tools available to SC homeowners with disputed roof claims, yet most homeowners have never heard of it. Nearly every homeowners insurance policy sold in South Carolina includes an appraisal provision.

How the Appraisal Process Works

Either party (you or the insurer) can invoke the appraisal clause when there is a disagreement about the amount of a loss. The process works as follows:

1. Invocation: You send written notice to your insurer stating you are invoking the appraisal clause. Reference the specific policy section.
2. Appraiser selection: Each side selects a competent, independent appraiser within 20 days (timeframes vary by policy).
3. Umpire selection: The two appraisers agree on an umpire. If they cannot agree, either party can ask an SC court to appoint one.
4. Inspection and valuation: Both appraisers independently inspect the property and prepare damage estimates.
5. Agreement attempt: The appraisers attempt to agree on the amount of loss. If they agree, the amount is binding.
6. Umpire decision: If the appraisers cannot agree, the umpire reviews both estimates and makes a decision. Agreement between any two of the three (your appraiser, their appraiser, or the umpire) is binding.

When to Invoke the Appraisal Clause

The appraisal clause is most effective when the dispute is about how much the damage is worth, not whether it is covered. If the insurer acknowledges that some storm damage exists but denies full coverage, or if the insurer's estimate is significantly lower than your independent estimate, appraisal is often the fastest resolution path. It is generally less effective when the insurer denies coverage entirely (argues no covered event occurred) -- though some SC courts have allowed appraisal to proceed even in coverage disputes.

Typical Costs and Timeline

Each party pays for their own appraiser. The umpire's fee is typically split between both parties. Your appraiser may cost between a few hundred and a few thousand dollars depending on the complexity of the claim. The entire process typically takes 30 to 90 days from invocation to resolution. Compared to litigation, which can take a year or more and cost tens of thousands in attorney fees, appraisal is significantly faster and less expensive.

Finding a Qualified Appraiser in SC

Your appraiser should be someone with direct experience in roof damage assessment and insurance claims -- typically a licensed public adjuster, a contractor with Xactimate experience, or an independent claims professional. They do not need to be in your city, but familiarity with Myrtle Beach construction methods, coastal building codes, and SC-specific storm damage patterns is valuable. Ask for references from prior appraisal cases they have handled in South Carolina.

A public adjuster is a licensed insurance professional who works for you, not the insurance company. They assess your damage independently, prepare their own estimate, and negotiate with the insurer on your behalf. In South Carolina, public adjusters must be licensed by the SC Department of Insurance.

What a Public Adjuster Does

• Independent damage assessment: They inspect your roof and property, document all damage, and prepare a comprehensive estimate (typically using Xactimate).
• Claims file review: They analyze the insurer's claims file to identify errors, omissions, or unfair practices.
• Direct negotiation: They communicate with the insurer on your behalf, presenting evidence and negotiating a fair settlement.
• Appeal support: They help prepare and submit appeal documentation.
• Appraisal representation: They can serve as your appraiser in an appraisal proceeding.

How Public Adjusters Are Paid

Public adjusters in SC work on a contingency basis -- they take a percentage of the claim settlement, typically 10% to 15%. SC law caps public adjuster fees in certain situations. They get paid only if you get paid, which aligns their interests with yours. However, the percentage comes out of your settlement, so factor that into your decision. On a large claim, the increase in payout typically exceeds the adjuster's fee by a significant margin.

When a Public Adjuster Is Worth It

• Your claim has been denied and you believe the denial is unjustified
• The damage is extensive and the claim is complex (multiple damage types, large scope)
• You do not have time to manage the appeal process yourself
• Your own negotiation efforts have not produced results
• The gap between the insurer's estimate and your contractor's estimate is substantial

When You May Not Need One

• The damage is minor and close to your deductible amount
• Your insurer has already approved the claim at a fair amount
• You have a knowledgeable roofing contractor who can handle the supplemental process
• The claim involves a clear coverage exclusion (flood damage without flood policy, for example)

How to Find a Licensed Public Adjuster in SC

Verify any public adjuster's license through the SC Department of Insurance website. Ask for references specific to roof damage claims in coastal SC. Avoid anyone who contacts you unsolicited after a storm -- reputable public adjusters rely on referrals, not door-knocking.

Insurance denial letters use specific language that often obscures the real reason for the denial. Understanding what these phrases actually mean helps you craft a targeted appeal.

Notice a pattern: most denial language shifts the burden to you. The insurer denies, and you must prove they are wrong. This is by design. Many homeowners accept the denial because they do not realize they can challenge it with evidence. Every phrase in the table above has been successfully countered by homeowners who took the time to build a proper appeal case.

Not all insurance disputes are the same. Understanding which category your situation falls into determines the best strategy.

The key distinction: a denied claim means the insurer says no. An underpaid claim means the insurer says yes, but not enough. Bad faith means the insurer's behavior violated their legal obligations. You may experience more than one -- a claim can be denied in bad faith, or underpaid in bad faith. Each situation may require a different strategy, and they are not mutually exclusive.

If your claim was underpaid rather than denied, read our detailed guide to fighting a lowball roof insurance offer in SC for the specific supplemental claims process.

Roof insurance claims in Myrtle Beach and the Grand Strand face unique challenges that inland homeowners do not encounter. Understanding these coastal-specific factors helps you build a stronger appeal.

Hurricane and Tropical Storm Damage

Myrtle Beach sits in one of the most hurricane-prone areas on the East Coast. When a named storm hits, insurance companies are flooded with claims and bring in temporary "catastrophe adjusters" who may not be familiar with coastal construction, SC building codes, or the specific ways that hurricane-force winds damage roofs in our area. These cat adjusters handle dozens of claims per day and spend minimal time on each property. The result: legitimate damage gets missed or misclassified.

Wind-Driven Rain Penetration

In Myrtle Beach, the combination of high winds and heavy rain during storms causes water to penetrate under shingles, through flashing, and around roof penetrations in ways that are not visible from a surface inspection. An adjuster who only looks at the shingles from the top will miss water damage to the underlayment, decking, and interior. This hidden damage is often discovered only during repairs, which is why supplemental claims are so common for coastal storm damage.

Salt Air Degradation vs. Storm Damage

One of the most contentious issues in coastal SC claims is distinguishing between salt air corrosion and storm damage. Insurers argue that metal components (flashing, vents, drip edge) deteriorated due to salt air exposure rather than storm impact. While salt air does accelerate corrosion, it does not cause the sudden bending, displacement, or tearing that storm winds produce. An experienced coastal roofing inspector can distinguish between gradual corrosion patterns and acute storm damage.

Separate Wind/Hail Deductibles

Many coastal SC policies have separate, percentage-based deductibles for named storm or wind/hail damage. These deductibles are significantly higher than the standard flat deductible. A homeowner with a 2% hurricane deductible on a $400,000 home faces an $8,000 deductible for hurricane damage, compared to perhaps a $1,000 standard deductible. Adjusters sometimes estimate storm damage just below the hurricane deductible, effectively denying the claim while technically acknowledging damage exists. If you believe the damage exceeds your deductible but the adjuster's estimate says otherwise, this is a clear case for an independent inspection and potential appraisal.

Documentation Tips for Coastal Homeowners

• Annual roof inspections: Get a professional inspection every year and keep the report. This creates a baseline that disproves "pre-existing damage" claims.
• Pre-storm photos: Before hurricane season, photograph your roof from every angle. Include close-ups of shingles, flashing, vents, and gutters.
• Post-storm documentation: Photograph damage immediately after the storm, before any temporary repairs. Include date stamps.
• Weather records: Save NOAA reports, local news coverage, and any National Weather Service alerts for your area.
• Neighbor coordination: Talk to neighbors about their claims. If multiple homes on your street sustained damage, that strengthens everyone's individual claim.

At Weather Shield Roofing, we work with Myrtle Beach homeowners who have had their roof insurance claims denied. We do not practice law and we are not public adjusters -- we are experienced roofing contractors who understand the insurance process and provide the documentation homeowners need to fight back.

Free Independent Roof Inspection

We provide a thorough, no-cost roof inspection for homeowners with denied claims. Our inspection includes every slope of the roof, all flashing and penetration points, the attic and interior for water intrusion, and detailed photographic documentation. This is not a quick glance from the driveway -- it is a comprehensive assessment that typically takes 60 to 90 minutes. The inspection report includes our professional assessment of the damage, photographs with annotations, and an independent repair or replacement estimate.

Documentation for Your Appeal

We produce a detailed written report that you can include with your appeal letter. The report documents what we found, differentiates storm damage from pre-existing conditions, and provides a professional estimate for the necessary repairs. Many homeowners have used our inspection reports to successfully overturn denied claims.

Meeting with the Insurance Adjuster

If the insurer sends a new adjuster for a re-inspection as part of your appeal, we can be present to walk the adjuster through the damage and ensure nothing is missed. Having a knowledgeable roofing professional on your roof alongside the adjuster significantly reduces the chance of a second denial based on a cursory inspection.