Roof Insurance Claim Denied? Here's What to Do Next

Don't Panic—You Have Options

A denied claim doesn't mean you're out of luck. Many denied claims are overturned on appeal with the right documentation and approach. Act quickly—there are deadlines for appeals.

Get Expert Help: (843) 877-5539

1. Why Was Your Claim Denied?
2. Immediate Steps After Denial
3. The Insurance Appeal Process
4. Documentation You Need for Your Appeal
5. When to Hire a Public Adjuster
6. Legal Options: When to Involve an Attorney
7. How a Roofing Contractor Can Help
8. Frequently Asked Questions

Why Was Your Claim Denied?

Understanding why your claim was denied is the first step to fighting back. Your denial letter should explain the specific reason, but insurance language can be confusing. Here are the most common denial reasons and what they really mean:

Common Denial Reasons

Denial Reason	What It Means	How to Fight It
Wear and tear / Age	Insurance says damage is from normal aging, not a storm	Get a contractor to document specific storm damage patterns
Pre-existing damage	Insurance claims damage existed before the storm	Provide prior inspection reports showing good condition
Maintenance issues	Insurance says damage resulted from lack of maintenance	Show maintenance records; get contractor to distinguish storm damage
Roof age limit	Policy limits or excludes coverage for roofs over certain age	Review policy carefully; may still cover partial or have exceptions
Cosmetic damage only	Policy excludes damage that doesn't affect function	Have contractor document functional impact (compromised seal, etc.)
Filed too late	Claim submitted after policy deadline	Explain circumstances; document when damage was discovered
Insufficient documentation	Not enough evidence to prove storm damage	Gather additional photos, weather data, contractor reports

Important: Get the Denial in Writing

If you received only a verbal denial, request a written denial letter with the specific reason(s) cited. You need this documentation for your appeal, and insurance companies are required to provide written explanations.

Immediate Steps After Denial

Time is critical after a denial. Take these steps immediately to protect your right to appeal:

Your 7-Day Action Plan:

1
Read the denial letter carefully – Identify the specific reason(s) for denial and any deadlines mentioned
2
Note your appeal deadline – Most companies give 30-60 days; mark this on your calendar
3
Request the adjuster's report – Call your insurance company and request a complete copy of the adjuster's inspection report and photos
4
Review your policy – Read the relevant sections about coverage, exclusions, and the appeals process
5
Get an independent roof inspection – Have a licensed contractor inspect and document all damage
6
Gather additional documentation – Weather reports, neighbor statements, previous inspection records
7
Decide on your appeal strategy – Self-appeal, public adjuster, or attorney involvement

The Insurance Appeal Process

Insurance companies have formal appeal procedures. Understanding this process helps you navigate it effectively:

Step 1: Internal Appeal

Most insurance companies require you to start with an internal appeal before taking other action. This involves:

Submitting a written appeal letter stating why the denial was incorrect
Providing additional documentation that supports your claim
Requesting a re-inspection if the original inspection was inadequate
Asking for a different adjuster if you believe the first was biased

Sample Appeal Letter Structure:

Opening: Your policy number, claim number, date of denial
Statement: "I am formally appealing the denial of my claim dated [date]"
Reason for denial: Quote the denial reason from their letter
Your counter-argument: Explain why the denial is incorrect with specific facts
Supporting evidence: List all documentation attached
Request: Ask for re-inspection and/or reconsideration
Deadline reminder: Note you expect response within [reasonable timeframe]

Step 2: Request Re-Inspection

You have the right to request a second inspection. For best results:

Request a different adjuster than the original
Have your roofing contractor present during the re-inspection
Prepare a list of all damage areas to ensure nothing is missed
Have your contractor point out specific storm damage indicators

Step 3: Appraisal Clause (If Applicable)

Most policies include an "appraisal clause" for disputes about damage amount (not coverage). If your claim was denied for "insufficient damage" or the settlement offer was too low:

You can invoke the appraisal clause to have an independent appraiser evaluate the damage
Each party (you and the insurance company) hires their own appraiser
The two appraisers select an "umpire" to decide disputed items
This is binding for the amount of damage, though not for coverage disputes

Documentation You Need for Your Appeal

Strong documentation is the key to overturning a denial. Gather everything possible:

Essential Documentation Checklist:

✓Independent contractor inspection report with detailed damage assessment
✓Photos of storm damage with timestamps and descriptions
✓NOAA weather data confirming the storm event (wind speeds, hail size)
✓Local news coverage of the storm
✓Neighbor statements confirming similar damage in the area
✓Previous inspection reports showing roof was in good condition before the storm
✓Maintenance records proving regular upkeep
✓Copy of the adjuster's original report to identify what was missed
✓Detailed contractor estimate showing full scope of repairs needed

Need a Professional Damage Assessment?

A detailed contractor inspection report is often the most persuasive evidence in an appeal. We provide free inspections and comprehensive documentation that has helped overturn many denied claims.

Free Inspection: (843) 877-5539

When to Hire a Public Adjuster

A public adjuster is a licensed professional who represents you (not the insurance company) in negotiating your claim. They can be valuable in certain situations:

When a Public Adjuster Makes Sense

•
Large claims ($10,000+) – Their expertise often recovers more than their fee
•
Complex damage – Multiple issues, hidden damage, or technical disputes
•
Repeated denials – Your internal appeal was also denied
•
Lack of time – You can't dedicate time to managing the appeal
•
Unfair treatment – You believe the insurance company is acting in bad faith

What Public Adjusters Cost

Public adjusters typically charge 10-15% of your settlement. While this seems high, consider:

Studies show public adjusters often recover 30-50% more than homeowners negotiating alone
They have expertise in policy interpretation and damage assessment
They handle all communication with the insurance company
In South Carolina, their fees are regulated and must be disclosed upfront

Warning: Verify Credentials

Public adjusters must be licensed in South Carolina. Verify their license with the SC Department of Insurance before signing any agreement. Be wary of anyone who contacts you unsolicited after a storm—legitimate public adjusters don't typically door-knock.

Legal Options: When to Involve an Attorney

If your appeal is denied and you believe the insurance company is acting in bad faith, legal action may be your next step:

Signs of Bad Faith

Unreasonable delays in processing your claim
Denial without proper investigation
Misrepresenting policy language to deny coverage
Failing to respond to communications
Offering a settlement far below obvious damage value
Changing the reason for denial after you counter the original reason

What an Insurance Attorney Can Do

Review your policy for coverage that was improperly denied
File a complaint with the SC Department of Insurance
Negotiate directly with the insurance company's legal department
File a lawsuit for breach of contract and/or bad faith
Pursue additional damages beyond the claim amount if bad faith is proven

Many insurance attorneys work on contingency for these cases, meaning you pay nothing unless you win.

How a Roofing Contractor Can Help

A reputable roofing contractor is one of your most valuable allies in fighting a denied claim:

How We Help with Denied Claims:

✓
Independent damage assessment – We provide detailed documentation of all storm damage
✓
Photo documentation – Professional photos showing specific damage patterns consistent with storm damage
✓
Re-inspection attendance – We can meet with the adjuster during re-inspection to ensure nothing is missed
✓
Detailed estimates – Line-item estimates that insurance adjusters can use for comparison
✓
Expert opinion – As certified roofing professionals, our assessment carries weight in disputes

Frequently Asked Questions

Why was my roof insurance claim denied?

Common denial reasons include: damage attributed to wear, age, or lack of maintenance rather than a covered event; filing too late after the damage occurred; pre-existing damage not caused by the claimed storm; roof age exceeding policy coverage limits; cosmetic damage exclusions; insufficient documentation; or policy exclusions for certain types of damage. Your denial letter should specify the exact reason.

Can I appeal a denied roof insurance claim?

Yes, you have the right to appeal a denied claim. Start by requesting a written explanation of the denial reason. Then gather additional documentation, photos, contractor reports, and weather data to counter their reasoning. Submit a formal appeal letter with supporting evidence. Most insurance companies have internal appeal processes, and you typically have 30-60 days to file an appeal.

When should I hire a public adjuster for a denied roof claim?

Consider hiring a public adjuster if: your claim involves significant damage (typically over $10,000), you believe the denial was unjustified, the insurance adjuster's assessment seems incomplete, you don't have time to manage the appeal yourself, or you've already had your internal appeal denied. Public adjusters typically charge 10-15% of your settlement but often recover more than this additional amount.

How long do I have to appeal a denied roof insurance claim in South Carolina?

In South Carolina, you typically have 1-3 years to file a lawsuit if your appeal is denied, depending on your policy terms and the type of claim. However, internal appeals usually have much shorter deadlines—often 30-60 days from the denial. Check your denial letter and policy for specific timeframes, and act quickly to preserve your rights.

Should I get a second opinion from another roofing contractor?

Absolutely. A second professional inspection can provide additional documentation of storm damage that supports your appeal. Different contractors may identify damage the insurance adjuster or first contractor missed. This independent assessment can be powerful evidence in your appeal, especially if the contractor is certified (like a HAAG-certified inspector) and can provide detailed reports.

Denied Claim? We Can Help.

At WeatherShield Roofing, we've helped many Myrtle Beach homeowners successfully appeal denied roof insurance claims. We provide free inspections, detailed damage documentation, and can attend re-inspections with insurance adjusters.

Call (843) 877-5539 Schedule Free Inspection

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