One of the most common complaints I have heard from insured homeowners as an inside claims adjuster is that the outside adjuster who inspected their storm damaged roof is only going to issue a check to pay for half of the roof–for one slope. At the request of the agent, insured, or contractor, I have the received the claim for additional review, called a supplement claim.
I will review the outside adjuster’s claim notes and photographs and discuss with the insured or their contractor. My job is to determine if there is possibly more storm-related damage than the outside adjuster found during the initial inspection. If a contractor or insured is stating there is more damage, then most likely the claim will go back out to the field for another inspection, with the contractor present.
Often the adjuster’s photos will clearly show that only one slope of the roof was damaged, say by hail, and the other slope was not damaged. While this does not seem possible to the layman, the nature of hail storms can make it possible. A hail storm can move over a neighborhood at a certain angle, from a certain direction and therefore as it passes only damage one side of a structure.
It can be difficult to help an insured understand a policy that may only pay precisely for what was damaged. The most common refrain is complaints about the roof not matching.
Many policies exclude matching concerns, but in a few states matching by the insurance company is a requirement. If you are not sure, ask your adjuster or agent.
Now, if there are a few damaged shingles on the opposing slope, and the adjuster finds that replacing just a few shingles will cause additional damage to the slope due to brittleness or age of shingles, the claim may be required to pay for the entire slope. Adjusters can perform what is called a brittleness test. Be advised a brittleness test should only be performed under certain temperature and weather conditions. Make sure the test on your roof was performed under proper conditions.
An adjuster may also find part of the roof has what is called mechanical damage, or damage caused by walking on the roof, wear and tear, tools used on the roof, bad installation of vents or roof pipes or flashing. These events probably are not covered under your home insurance policy. In addition, a common damage found is rotted decking or plywood, the surface upon which the roof shingles lay. Since most rotted wood is a long-term event, and not considered sudden and accidental, it would probably not be covered either.
Tile roofs present a different approach and adjusters will commonly only pay for individual tiles that are damaged. A contractor attempting to have the entire roof replaced may make a case that the remaining tiles will become damaged or cracked as they replace the storm damaged tiles, but an adjuster usually will not allow this because there is no coverage for anticipated damage – damage that has not yet happened.
Insured will also allow a contractor to upgrade their shingles to the latest-greatest, using the logic they are doing the insurance company a favor because better shingles might mean no damage during the next storm, and the shingles will last longer. However, most policies are clear they will pay to replace with like, kind and quality. An upgrade will usually be an out of pocket expense of the insured.
If after a second inspection which is in agreement with the first adjuster, that only one roof slope is storm damaged, and you and your contractor still disagree, ask your adjuster for the next step in the process. Sometimes a third inspection might take place, with different adjusters and with managers present. If that inspection agrees with the previous two, there may be other procedures such as appraisal and arbitration – both still within the insurance claims process and not a legal court matter.
If three inspections do not find damage to the second roof slope, chances are very good there are no covered damages to the second slope. However, the process has room for insured who continue to disagree. In the end, even though an insured would like a whole brand new roof, their insurance may not pay for it if not all the roof is damaged.
This article is by no means all-comprehensive as there are many scenarios involving roofs and roof damage and claims. Policies and claims vary with different insurers and states. If you have questions you should speak with your adjuster or your agent.