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Why Roofing Insurance Claims Get Denied (And How to Fix It)

A claim denial doesn't just lose you one job — it loses you a customer, damages your reputation, and wastes every hour you invested in that lead from the first door knock to the adjuster meeting.

Across the 2,400+ claims tracked in our system, approximately 14% of initial claims are denied outright. That's 1 in 7 jobs where the contractor walks away empty-handed. But here's the important part: the vast majority of those denials are preventable.

When we analyzed the denied claims in our database, clear patterns emerged. The same seven reasons account for 91% of all denials. And for each one, there's a specific prevention strategy that top contractors use to avoid it.

The 7 Most Common Denial Reasons

1. Pre-Existing Damage / Wear and Tear (29% of denials)

What happens: The adjuster determines that the damage is due to age, deterioration, or deferred maintenance — not the storm event. The carrier denies the claim, stating the damage is "pre-existing" or "wear and tear."

Why it happens: This is the most common denial and often the most frustrating. Sometimes the adjuster is right — the roof was at end of life before the storm. But frequently, the adjuster attributes storm damage to wear because the contractor didn't provide adequate evidence connecting the damage to the specific storm event.

How to prevent it:

Document the date of the storm event and the specific weather data (hail size, wind speed, storm path)
Take inspection photos that clearly show impact marks, bruising, and granule displacement consistent with hail — not just general wear patterns
Photograph collateral damage (dented gutters, damaged AC units, pocked siding) that corroborates a hail event
Note the roof's age and condition honestly in your documentation. A 15-year-old roof can absolutely sustain storm damage — but pretending it's in perfect pre-storm condition undermines your credibility
Use photo documentation tools that timestamp and geotag every image automatically

2. Insufficient Documentation (21% of denials)

What happens: The carrier requests supporting evidence for the claim — photos, measurements, code references — and the contractor can't produce it. The claim is denied for lack of evidence.

Why it happens: Documentation standards in the insurance industry have tightened significantly over the past five years. What used to be approved on a field adjuster's word now requires photo evidence, measurements, and written justification. Contractors who still rely on "the adjuster saw it" are getting burned.

How to prevent it:

Capture a minimum of 50 photos per inspection: 4+ full-elevation shots, close-ups of every damage point, measurements, flashings, penetrations, and collateral damage
Every photo should include GPS coordinates, timestamp, and photographer ID
Create a documentation checklist and don't leave the property until every item is captured
Store everything in a centralized claims management system — not a personal phone or email thread

3. Damage Below Deductible (15% of denials)

What happens: The adjuster confirms damage but determines the repair cost is below the homeowner's deductible. There's technically nothing to claim.

Why it happens: This is a legitimate denial — if the repair cost is genuinely below the deductible. But in many cases, the adjuster underscoped the damage or missed legitimate line items that would push the total above the deductible.

How to prevent it:

Before scheduling the adjuster meeting, do your own estimate. If it's close to the deductible threshold, be extra thorough in your documentation
Identify all damage — not just the roof. Gutters, downspouts, window screens, siding, paint, and HVAC units are all part of the same claim event
Don't forget code upgrade items (drip edge, ice & water shield) that add to the total scope
If the adjuster's scope is below the deductible but yours is above it, supplement immediately

4. Policy Exclusions (11% of denials)

What happens: The homeowner's policy specifically excludes the type of damage or the type of roof. Common exclusions include cosmetic damage exclusions (CDE), actual cash value (ACV) policies on older roofs, and wind/hail deductible carve-outs.

Why it happens: Many homeowners don't fully understand their policy, and contractors don't review the policy before investing time in the claim. A cosmetic damage exclusion, for example, can exclude hail damage that doesn't affect the functional integrity of the roof — even if the damage is clearly visible.

How to prevent it:

Review the homeowner's policy declaration page before filing the claim. This takes 5 minutes and can save you days of wasted effort
Look specifically for: cosmetic damage exclusions, wind/hail deductible percentages, ACV vs. RCV coverage, and roof age limitations
If the policy has a CDE, focus your documentation on functional damage — cracked shingles, exposed mat, dislodged shingles — not just cosmetic bruising
Educate the homeowner about their coverage before setting expectations about what the insurance will pay for

5. Missed Filing Deadlines (9% of denials)

What happens: The homeowner or contractor files the claim after the carrier's deadline has passed. Many policies require notice within 12 months of the damage event, and some states have shorter windows.

Why it happens: Homeowners don't always realize they have damage right away. A hail event in March might not show symptoms until a leak appears in October. By then, the homeowner may have missed the filing window — or the evidence has deteriorated.

How to prevent it:

File claims as quickly as possible after identifying damage. Same day or next day is ideal
Track filing deadlines by carrier in your CRM. Different carriers have different windows
When canvassing older storm areas, check the storm date against common policy deadlines before investing inspection time
Document the storm date and the homeowner's date of discovery separately — some policies use "date of discovery" rather than "date of loss"

6. No Storm Event Verified (8% of denials)

What happens: The carrier can't verify that a qualifying storm event occurred at the property's location. They deny the claim on the basis that there's no confirmed weather event to attribute the damage to.

Why it happens: NOAA storm reports, hail swath data, and Spotter Network confirmations don't cover every square mile. A neighborhood may have experienced genuine hail, but if the official records don't confirm it within a reasonable radius, the carrier may deny.

How to prevent it:

Document the storm event with multiple data sources: NOAA storm reports, local weather radar, SPC storm reports, and Spotter Network confirmations
Photograph collateral damage that corroborates the event: dented mailboxes, damaged cars, pocked siding on multiple properties
Get neighbor statements or photos if possible — evidence of area-wide damage supports the claim that a storm event occurred
Time-stamp your canvassing and inspection GPS data to show you were in the area during or immediately after the event

7. Contractor / Claim Fraud Red Flags (7% of denials)

What happens: The carrier's Special Investigations Unit (SIU) flags the claim for suspected fraud. This can range from genuine fraud to false positives triggered by documentation inconsistencies.

Why it happens: Carriers use pattern detection algorithms to flag claims. Red flags include: inspection photos with inconsistent timestamps, damage patterns that don't match the reported storm type, multiple claims from the same contractor with identical documentation, and estimates that significantly exceed comparable claims in the area.

How to prevent it:

Never fabricate or alter documentation. This should go without saying, but it happens, and it ruins careers and companies
Use tools that automatically embed unalterable metadata in photos — GPS, timestamp, device ID
Be honest about pre-existing conditions in your documentation. Acknowledging a roof's age and wear actually builds credibility with adjusters
If your estimate is significantly higher than comparable claims, include a detailed written justification explaining why (complex roof geometry, premium materials, code-required upgrades)

The Role of Documentation in Preventing Denials

If you read through all seven denial reasons above, you'll notice a theme: documentation quality is the single biggest factor in claim outcomes.

The contractors with 89%+ approval rates in our system share these documentation habits:

Photo volume: Average of 67 photos per inspection (vs. 23 for contractors with below-average approval rates)
Metadata consistency: 100% of photos geotagged and timestamped
Written narratives: A brief written summary accompanying every claim describing the damage, the storm event, and the scope of repairs
Code citations: Specific building code references for every code-required line item
Organized submission: Professional supplement packages with clear formatting, labeled sections, and logical ordering

Photo intelligence tools that automatically organize, tag, and prepare documentation can turn a 2-hour documentation task into a 15-minute one — and produce a more professional result.

Adjuster Relationship Management

Adjusters are not your adversaries. They're professionals doing a job within the constraints of their carrier's guidelines. How you interact with them directly affects your claim outcomes.

Do:

Be professional, prepared, and on time for every adjuster meeting
Bring organized documentation — don't make the adjuster wait while you scroll through your phone
Ask questions about their scope. "I noticed drip edge wasn't included — is that something we can discuss?" is collaborative, not confrontational
Follow up in writing after meetings to confirm what was discussed and agreed
Learn their names, remember their preferences, and build a professional reputation

Don't:

Argue on the roof. If you disagree, submit it in writing as a supplement
Badmouth the carrier or previous adjusters
Pressure the adjuster for an answer on the spot. Give them time to process
Go over the adjuster's head to their supervisor as a first move. Escalation should be a last resort, not a first response

Adjusters talk to each other. Your reputation precedes you. Contractors known for thorough, honest documentation and professional communication get the benefit of the doubt. Contractors known for inflated claims and confrontational behavior get scrutinized.

Technology That Reduces Denials

Modern claims management technology directly addresses the documentation and process gaps that cause denials:

Claims workflow systems: Ensure every claim follows a consistent process with required documentation at each stage. Jobs can't advance until required photos, measurements, and documents are captured.

Photo intelligence: Automatic geotagging, timestamping, organization, and tagging. No more lost photos or disputed metadata.

AI-powered supplement identification: Automatically compare carrier estimates against your scope and flag missing items with the correct Xactimate codes and supporting documentation.

Automated follow-up: Reminders for filing deadlines, supplement response windows, and adjuster meeting prep ensure nothing falls through the cracks.

When to Push Back on a Denial

Not every denial is final. If you believe the denial is wrong, you have options:

Request a re-inspection. Ask for a different adjuster to evaluate the damage. Provide any new evidence or documentation that wasn't available during the first inspection.
Submit a formal appeal. Most carriers have an appeals process. Your appeal should include: the specific reason for denial, why you disagree (with evidence), and any new documentation supporting your position.
Invoke appraisal or mediation. Many policies include an appraisal clause that allows both parties to hire independent appraisers to determine the actual loss amount. This is often more effective than continued back-and-forth with the carrier.
Consult a public adjuster or attorney. For high-value claims where you've exhausted internal remedies, a licensed public adjuster or insurance attorney can advocate on the homeowner's behalf.

Important: Always advise the homeowner of their options. The claim belongs to the homeowner, not to you. Your role is to advocate, document, and support — not to make legal or insurance decisions on their behalf.

Conclusion

Claim denials are frustrating, but they're largely preventable. The seven reasons outlined here account for 91% of all denials, and each one has a specific, actionable prevention strategy.

The common thread is simple: document thoroughly, file promptly, know the policy, and maintain professional relationships with adjusters. Contractors who do these four things consistently achieve approval rates above 85% — and they rarely get surprised by a denial.

For a comprehensive walkthrough of the entire claims process from start to finish, read our complete guide: The Complete Storm Damage Roofing Claims Process.

Why Roofing Insurance Claims Get Denied (And How to Fix It)