Roof Insurance Claim Denied? What Myrtle Beach Homeowners Should Do
Shocking Industry Truth
Opening a denial letter from your insurance company after roof damage is devastating. You're paying premiums for protection, and when you need it most, you're told "no." But a denial is not the final word. Many initially denied claims are successfully overturned through proper appeal processes.
This guide covers everything you need to know about appealing a denied roof insurance claim: understanding why claims get denied, gathering the right documentation, the formal appeal process, when to hire a public adjuster, how contractors can help, and when legal action makes sense.
At WeatherShield Roofing, we've helped hundreds of Myrtle Beach homeowners navigate insurance claims, including many that were initially denied. We're 5.0★ rated on Google (81 reviews) and provide free claim assistance including documentation, adjuster meeting support, and professional damage assessments. This guide shares what we've learned about turning denials into approvals.
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Understanding Why Your Claim Was Denied
Before you can effectively appeal, you need to understand exactly why your claim was denied. Insurance companies must provide a written explanation, but the language can be confusing. Here are the most common denial reasons and what they actually mean.
1. "Wear and Tear" or "Maintenance Issue"
What they're saying: The damage was caused by normal aging or lack of maintenance, not a covered event.
The Reality
This is the most common and most frequently misapplied denial reason. Adjusters sometimes attribute storm damage to wear and tear when evidence suggests otherwise. A roof in good condition before a storm that suddenly leaks after is likely storm damage, not wear and tear.
How to challenge: Provide pre-storm documentation showing roof was in good condition. Get a professional inspection report from a licensed contractor identifying specific storm damage indicators.
2. "Pre-Existing Damage"
What they're saying: The damage existed before the claimed storm/event.
How to challenge: Provide documentation of prior inspections, past claim history showing no damage, photos before the event, or maintenance records. A contractor's assessment can often distinguish between fresh damage and old damage based on weathering patterns.
3. "Damage Below Deductible"
What they're saying: Repair costs don't exceed your deductible, so there's nothing to pay.
How to challenge: Get a detailed repair estimate from a licensed contractor. Insurance adjusters sometimes underestimate repair scope. If your contractor's estimate significantly exceeds the adjuster's, request a re-inspection.
4. "Not a Covered Peril"
What they're saying: The type of damage isn't covered by your policy.
Common Policy Exclusions
- Flood damage: Requires separate flood insurance (common issue in Myrtle Beach)
- Cosmetic hail damage: Some policies exclude dents that don't affect function
- Mold/rot: Often excluded or limited
- Neglect: Damage worsened by failure to mitigate
How to challenge: Review your policy carefully. The damage may be covered even if the adjuster claimed otherwise. Sometimes claims are denied as "flood" when the actual cause was wind-driven rain (which IS typically covered).
5. "Late Filing"
What they're saying: You didn't report the damage within the policy's required timeframe.
How to challenge: If you discovered damage late, document when you first noticed it. South Carolina law may provide protections for late discovery. The filing clock typically starts when you discover the damage, not when it occurred.
6. "Policy Exclusion"
What they're saying: A specific exclusion in your policy applies to this damage.
How to challenge: Request the exact policy language being cited. Have an attorney or public adjuster review whether the exclusion actually applies. Exclusions are often more narrow than adjusters suggest.
Gathering Documentation for Your Appeal
A successful appeal requires strong documentation. The more evidence you can provide, the better your chances of overturning the denial.
Essential Documentation Checklist
From Your Insurance Company
- ☐ Written denial letter with specific reasons
- ☐ Copy of your complete policy (request if you don't have it)
- ☐ Adjuster's inspection report and photos
- ☐ Any estimates or damage assessments they prepared
From You
- ☐ Photos/videos of damage (as many angles as possible)
- ☐ Photos showing roof condition BEFORE the event (if available)
- ☐ Maintenance records, prior inspection reports
- ☐ Timeline of when you discovered damage
- ☐ Notes from any conversations with your adjuster
- ☐ Receipts for any temporary repairs/mitigation
From Licensed Contractor
- ☐ Professional damage assessment/inspection report
- ☐ Detailed repair estimate with line items
- ☐ Photos documenting specific damage indicators
- ☐ Written statement identifying cause of damage
- ☐ Contractor's license and insurance information
Weather Documentation
Proving a storm occurred is crucial for storm damage claims:
Where to Get Weather Data
- NOAA weather history: Official wind speeds, hail reports
- National Weather Service: Storm event databases
- Local news archives: Storm coverage with damage reports
- Hail reports: Available from various weather tracking services
- Neighbor claims: Evidence that others in your area had damage
The Contractor's Inspection Report
A professional inspection report from a licensed contractor is often the most valuable piece of appeal documentation. A good report should include:
- Overall roof assessment: Age, condition, materials
- Specific damage findings: Location, extent, type
- Cause determination: Why this is storm damage vs wear and tear
- Code compliance issues: Any code upgrades required
- Photographic evidence: Detailed photos with annotations
- Repair scope: What needs to be done to properly fix the damage
- Professional credentials: License number, certifications
Free Claim Documentation
WeatherShield Roofing provides free comprehensive damage assessments for insurance claims, including:
- • Detailed written inspection report
- • Extensive photo documentation
- • Professional assessment of damage cause
- • Itemized repair estimate
Call (843) 877-5539 for your free assessment.
The Formal Appeal Process
Insurance companies have formal appeal processes you can use to challenge denials. Here's how to navigate them effectively.
Step 1: Request a Re-Inspection
Your first step should be requesting a re-inspection with a different adjuster. You have this right, and it's often successful if the original adjuster missed damage.
For the Re-Inspection
- • Have your contractor present to point out damage
- • Bring your contractor's inspection report and photos
- • Be prepared to access the roof safely
- • Document everything that's discussed
- • Take your own photos during the inspection
Step 2: Submit a Written Appeal
If re-inspection doesn't resolve the issue, submit a formal written appeal. Your appeal letter should include:
- Policy information: Number, effective dates, coverage type
- Claim information: Claim number, date of loss, denial date
- Clear statement: "I am formally appealing the denial of claim #..."
- Point-by-point response: Address each denial reason specifically
- Supporting evidence: Reference all attached documentation
- Requested action: What you want them to do (approve claim, re-inspect, etc.)
- Deadline: Request response within 30 days
Step 3: Escalate Within the Company
If your initial appeal is denied, you can request escalation to:
- Claims supervisor: First level of escalation
- Claims manager: Has more authority to settle
- Executive customer relations: Handles escalated complaints
Step 4: Invoke Appraisal Clause
Most policies contain an appraisal clause for disputes over damage amounts. This process involves:
The Appraisal Process
- You and the insurance company each hire an appraiser
- The two appraisers attempt to agree on damage value
- If they can't agree, they select an umpire
- The umpire makes a binding decision
- You typically split umpire costs with insurer
Important Note
Appraisal only addresses the VALUE of damage, not whether the damage is covered. If coverage itself is the dispute, appraisal won't help.
Step 5: File a Complaint with SC DOI
The South Carolina Department of Insurance regulates insurers and investigates complaints. Filing a complaint can motivate insurers to reconsider.
When to File a DOI Complaint
- • Insurance company isn't responding to appeals
- • You believe they're acting in bad faith
- • Policy terms are being misrepresented
- • Excessive delays in claim processing
File online at doi.sc.gov or call 803-737-6160
When to Hire a Public Adjuster
Public adjusters are licensed professionals who work for YOU (not the insurance company) to handle your claim. They can be valuable allies in complex or denied claims.
What Public Adjusters Do
- Inspect your property: Document all damage thoroughly
- Review your policy: Identify all applicable coverages
- Prepare your claim: Create detailed damage estimates
- Negotiate with insurance: Handle all communication and meetings
- Manage appeals: If claims are denied or underpaid
When a Public Adjuster Makes Sense
Good Candidates
- ✓ Large, complex claims
- ✓ Claims that have been denied
- ✓ Significantly underpaid claims
- ✓ You don't have time to manage claim
- ✓ Multiple claim types (roof + interior)
May Not Be Worth It
- • Small, straightforward claims
- • Claims already fairly settled
- • Clear-cut coverage situations
- • When claim is near deductible
Public Adjuster Costs
Public adjusters typically charge a percentage of your settlement:
- Standard claims: 10-15% of settlement
- Reopened/denied claims: 15-20% of recovered amount
- South Carolina cap: 10% for hurricane claims in first year after storm
Are They Worth the Fee?
Studies suggest public adjusters increase claim payouts by 30-50% on average. For a denied claim where you'd otherwise get nothing, even a 15% fee is worthwhile. For claims that are slightly underpaid, do the math carefully.
Choosing a Public Adjuster
What to Look For
- • Licensed in South Carolina (verify at doi.sc.gov)
- • Experience with roof/storm damage claims
- • Local presence and reputation
- • Clear fee structure in writing
- • References from past clients
- • No upfront fees (they work on contingency)
Warning: Storm Chasers
After major storms, unlicensed "public adjusters" appear. Always verify licensing. Legitimate public adjusters never request upfront payment and won't pressure you to sign immediately.
How Your Roofing Contractor Can Help
A good roofing contractor is often your best ally in insurance claim disputes. While contractors can't negotiate your claim (that would be unlicensed public adjusting), they provide crucial technical expertise.
What Contractors CAN Do
- Professional damage inspection: Identify all damage the adjuster may have missed
- Detailed documentation: Photos, measurements, written reports
- Cause determination: Professional opinion on whether damage is storm-related
- Accurate repair estimates: Line-item estimates that match Xactimate pricing
- Meet with adjuster: Be present during re-inspections to point out damage
- Supplement requests: Document additional damage found during repairs
The Adjuster Meeting
Having your contractor present when the adjuster inspects can significantly improve outcomes:
Why It Matters
- • Contractors know what to look for that adjusters may miss
- • Professional-to-professional communication is more effective
- • Contractor can explain why certain repairs are necessary
- • Creates documentation of what was discussed
- • Prevents "he said, she said" disputes later
Estimate Comparison
If your contractor's estimate significantly exceeds the adjuster's, ask them to explain the differences:
| Common Differences | Why It Matters |
|---|---|
| Scope of damage | Adjuster may have missed damage on back of house or in valleys |
| Code upgrades | Repairs may require bringing roof up to current code |
| Related damage | Flashing, vents, gutters damaged along with shingles |
| Labor rates | Coastal SC rates may differ from adjuster's pricing database |
Supplement Process
Often, additional damage is discovered once roof work begins. Your contractor can file a "supplement" for this additional work:
- Contractor documents newly discovered damage with photos
- Contractor prepares supplemental estimate
- Supplemental request sent to insurance company
- Adjuster may re-inspect or approve based on documentation
- Additional funds released if approved
WeatherShield Insurance Claim Support
We provide comprehensive insurance claim assistance at no additional cost:
- • Free damage inspection and documentation
- • Attend adjuster meetings on your behalf
- • Prepare detailed Xactimate-format estimates
- • Handle supplement requests
- • Work with your public adjuster if you hire one
Call (843) 877-5539 to discuss your claim situation.
When to Consider Legal Action
If internal appeals, public adjusters, and DOI complaints haven't resolved your denied claim, legal action may be your final option.
Signs You May Need an Attorney
- Bad faith denial: Insurer ignored evidence, misrepresented policy terms
- Significant claim value: Large enough to justify legal costs
- Repeated denials: All internal appeals exhausted
- Policy dispute: Disagreement about what policy covers
- Unreasonable delays: Insurer stalling without valid reason
Bad Faith Insurance Claims
South Carolina allows policyholders to sue insurers for "bad faith" - unreasonable denial or delay of valid claims. Bad faith can result in:
- Payment of original claim amount
- Consequential damages (additional costs you incurred due to denial)
- Attorney's fees
- Punitive damages in egregious cases
Finding an Insurance Attorney
What to Look For
- • Specializes in insurance disputes (not general practice)
- • Experience with property damage claims
- • Works on contingency (no upfront cost)
- • Licensed in South Carolina
- • Willing to provide free consultation
Cost Considerations
Most insurance dispute attorneys work on contingency, typically 25-40% of recovery. Only pursue legal action if:
- Claim value justifies potential attorney fees
- You have strong evidence the denial was improper
- You're prepared for a process that may take 1-2+ years
Statute of Limitations
South Carolina has time limits for filing insurance lawsuits. Generally 3 years from date of loss, but policies may have shorter contractual limits. Don't wait too long to consult an attorney if you're considering legal action.
The Cost Comparison: Maintenance vs. Neglect
Without Maintenance
- Roof lifespan: 12-15 years
- Insurance claims often denied
- Emergency repairs cost 3x more
- Property value decreases by 5-10%
- Warranty becomes void
- Total 20-year cost: $35,000+
With Regular Maintenance
- Roof lifespan: 25-30+ years
- Insurance claims approved
- Prevent costly emergencies
- Property value protected
- Full warranty coverage maintained
- Total 20-year cost: $8,000-10,000
Don't Wait Until It's Too Late
Every day you delay costs you money. Get your FREE professional roof inspection today and discover exactly what condition your roof is in.
Emergency? Call our 24/7 hotline: (843) 877-5539
Need Professional Help?
WeatherShield Roofing is Myrtle Beach's highest-rated roofing company with a perfect 5.0-star Google rating. We can help with any roofing need:
Frequently Asked Questions
About the Author
David Karimi
Owner & Lead Roofing Contractor
David Karimi is WeatherShield Roofing's owner with over 18 years of experience in residential roofing and insurance claim assistance. Having helped hundreds of Myrtle Beach homeowners navigate the insurance claim process, David understands both the technical and procedural aspects of successful claims.
The Bottom Line: Your Roof, Your Choice
Every day you wait is another day closer to that emergency call no homeowner wants to make. The statistics are clear: 80% of roofs fail prematurely, and 61% of homeowners can't afford the emergency repairs that follow.
What You Get with Weather Shield Roofing:
Don't Wait Until It's Too Late
Join thousands of smart Myrtle Beach homeowners who protect their investment with regular maintenance.
Emergency? Call our 24/7 hotline: (843) 877-5539
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