Roof insurance claims, from the homeowner’s side

What follows is how the process actually runs, in the order it runs in. It is not advice about your policy — nobody can give you that without reading it — and it is not a promise about any outcome. It is the map.

In Pico Rivera the failure that leads is dry offshore wind that arrives all at once in autumn, and that shapes what a claim here usually looks like. Dry offshore wind lifts material that damp coastal air had been holding down. Most wind losses here happen on a handful of nights a year.

The order things happen in

The process is: loss, evidence, mitigation, notice, inspection, scope, payment, work, final payment. Insurers are used to it and run it many times a day; the homeowner is doing it for the first and probably only time, and that asymmetry is the real difficulty rather than any individual step being hard.

It helps to think of it as a file being built rather than a decision being made. Everything you send becomes part of the file, and the file is what gets decided on — not the roof.

The documentation that actually matters

Photograph before you touch anything. Wide shots that establish the whole house and locate the damage on it; close shots of each damaged area; photographs of undamaged areas of the same roof for comparison, which is the one people skip and the one that most helps you; and the interior, including ceilings, walls and the attic. Then photograph the temporary repairs after they are done, so there is a clear record of what was storm damage and what was mitigation.

An adjuster can work with photographs. They cannot work with a description, and they will not take your word for what was there before the tarp went on.

What to have ready:

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

What the adjuster looks at

Adjusters look for corroboration. Impact marks on the shingles alone are arguable; impact marks on the shingles plus dents in the gutter faces, the downspouts, the vent hoods and the air-conditioning fins tell a consistent story about one event, and consistency is what carries. This is also why the undamaged-slope photographs help you rather than hurt you: they establish a baseline.

It is entirely reasonable to be present for the inspection and to ask what they are recording. It is also reasonable to ask that your contractor be there, and many are willing to attend — that single arrangement changes more claim outcomes than anything else on this page.

What to find out first

A written contractor assessment before the adjuster’s visit gives you something to compare the adjuster’s scope against, which is the difference between a conversation and a disagreement. Most reputable local contractors will do this without charge, and it does not commit you to using them.

Ask for it in writing and itemised, with photographs. An assessment that exists only as an opinion expressed in your driveway is not usable later.

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

On a replacement cost policy the payment normally arrives in two parts, and this surprises almost everybody. The first cheque is the actual cash value: the full repair cost, less depreciation, less your deductible. The remainder — the "recoverable depreciation" — is released only after the work is actually finished and you have submitted an invoice proving it. It is not a reduction in what you are owed. It is money being held until the roof exists.

Two consequences follow. First, the first cheque will look far too small, and that is normal rather than a denial. Second, if you never do the work, you never receive the second half — so taking the first payment and living with the damaged roof means accepting the depreciated figure permanently.

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.

Making it safe, and getting paid for having done so

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.

Repair, replace, and the matching problem

Insurers pay to restore what was damaged, not to improve the house. So the fight is rarely about whether there is damage; it is about how much of the roof has to come off to fix it. An insurer may scope one slope. A contractor may say the slope cannot be repaired without the replacement being obvious, or that the material is no longer made in that colour, or that repairing into brittle old shingles will damage more than it fixes.

This is the single most common point of disagreement in roof claims, and it is a technical argument rather than a moral one. It is resolved by a contractor and an adjuster looking at the same roof and talking, which is why having your contractor present is worth arranging.

The clock, in both directions

Two clocks run and only one of them is obvious. The visible one is how long the insurer takes: most states set regulatory deadlines for acknowledging a claim, for deciding it, and for paying once it is accepted, and these are usually counted in days rather than months. Your state insurance department publishes the actual numbers, and they are enforceable.

The other clock is yours, and it is the one that ends claims. Policies require prompt notice of a loss and set an outer limit on how long after the event you can report it. Damage discovered late — hail in particular, because it hides — is denied on this basis more often than on any question about the damage itself.

A denial is a document, and documents can be answered

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.

What it comes down to

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.