The Roof Insurance Claim Process Start to Finish

Almost every avoidable problem in a roof claim traces back to somebody operating outside their role. Four parties matter:

That last line is not a technicality. It is the reason a good contractor will happily spend an hour showing you photographs of your own roof and then decline to tell you what your policy owes you. Carolina Trophy Roofs sets that boundary out explicitly in its own claim resources — the contractor documents and builds; the policyholder files and decides; disputed adjusting goes to someone licensed for it.

1. 1

   Notice of loss

   You report the loss to the carrier and a claim number is created. Policies universally contain a condition requiring notice within some window — commonly phrased as “prompt” or “as soon as practicable” rather than a fixed number of days — and separately a deadline for filing suit. Both run from the date of loss, not from the date you noticed the damage, which is why storm claims and slow-leak claims behave very differently.

   You will be asked for a specific date of loss. On a hail or wind event that date is knowable; see documenting roof damage for a claim for how it gets established from public weather records.

2. 2

   Emergency mitigation

   Policies impose a duty to protect the property from further damage, and reasonable emergency costs — tarping, board-up, water extraction — are ordinarily handled as part of the claim. Keep the invoices and photograph the damage before the tarp goes on. Mitigation that destroys the evidence of what caused the loss creates a problem later that is entirely avoidable.

3. 3

   The adjuster inspection

   The carrier assigns an adjuster who inspects the roof, decides what damage is attributable to the reported cause of loss, and takes measurements and photographs. After large catastrophes this may instead be a desk review of aerial or drone imagery, with a field inspection only if something is contested.

   Contractors commonly attend, and there is nothing improper about that: the person who will build the roof pointing out a lifted flashing or a cracked boot is construction information, not claim negotiation. The distinction the trade draws is between showing what is on the roof and arguing what the policy owes.

4. 4

   The scope, and then the estimate

   Scope comes first and matters more. Scope is the list of what is being repaired or replaced: which slopes, how many squares, whether the decking is included, whether the gutters and the detached garage are in, whether code-required upgrades that are triggered by the repair are in. The estimate is just that list priced out.

   Both sides typically price using the same line-item estimating platforms and regional unit price databases, which is why two estimates for the same roof usually differ on content rather than on unit cost. When a contractor’s number is far above the carrier’s, the gap is nearly always line items that are present in one and absent from the other, not a disagreement about the price of a bundle of shingles.

5. 5

   Depreciation, deductible and the first payment

   The carrier applies depreciation and the deductible to the approved estimate and issues a payment. On a replacement cost policy this first payment is the depreciated amount, not the full one — the arithmetic is worked through in the next section.

6. 6

   Supplements

   Once the tear-off happens, things appear that nobody could see from the surface: rotted decking, a second layer, a chimney flashing that was never a flashing. A supplement is a request to add those discovered items to the approved scope, supported by photographs taken before they are covered back up. Supplements are a normal, expected part of the process, not a sign that something went wrong.

7. 7

   Completion and the depreciation release

   On a replacement cost policy the withheld depreciation is released after the work is actually done and documented — final invoice, proof of completion, sometimes photographs. This is the step most often left on the table, usually because the paperwork closing the loop never gets submitted.

The single most common surprise in a roof claim is that the first cheque is much smaller than the estimate. That is usually the policy working exactly as written. Here is the structure, using round numbers purely to show the mechanics — these are not typical figures and not a prediction about any policy:

Recoverable versus non-recoverable

The difference is a single provision. Under replacement cost settlement the depreciation is a holdback — the carrier is keeping it until you prove you actually replaced the roof rather than pocketing the cash. Under actual cash value settlement it is simply not owed. Some policies also attach a roof schedule that steps the settlement basis down as the roof ages, so a house with replacement cost coverage on the structure can still have a roof settled on a depreciated basis. Which one applies to you is a question for your agent or carrier, in writing, before a storm rather than after.

Why your mortgage company is on the cheque

If there is a loan on the house, the lender is named on the policy and will be named as a payee on property damage payments above whatever threshold it sets. Endorsing that cheque into a lender-held escrow, which then disburses against inspections as the work progresses, is routine and is not anybody obstructing anything. It does mean the money moves on the lender’s schedule, and that schedule should be understood before a contractor is asked to start.

• ●Carolina Trophy Roofs on working with adjusters — a contractor’s account of what happens at the inspection, including the difference between staff and independent adjusters.
• ●Mantis Claims Group on what a public adjuster actually does — written by a licensed public adjusting firm, including how the fee structure works and when representation is and is not worth it.
• ●The National Association of Insurance Commissioners’ consumer resources — the regulators’ own material, including how to reach your state insurance department.