Common reasons claims are denied or underpaid
Every insurer and policy is different, but these are the reasons homeowners run into most often.
Wear and tear or age, not storm damage
Homeowners insurance pays when a covered peril caused the loss. Poor home maintenance is a typical exclusion, so if the adjuster concludes shingles failed from age or deterioration rather than wind or hail, the claim may be denied.
The claim was reported late
Policies set requirements for how quickly you report damage. Waiting a long time can also make it harder to show that a specific storm caused the damage. Check your policy's terms and report promptly.
Not enough documentation
Without dated photos, a storm date, and a clear record of what was damaged, it is harder to show when and how the damage happened. See our storm damage documentation checklist.
Earlier or unrepaired damage
If damage appears to predate the storm, or earlier damage was never repaired, the insurer may decline to pay for it and limit payment to what it ties to the new event.
Cosmetic damage
Some policies limit or exclude damage that affects only how a roof looks, not how it performs. The Ohio Department of Insurance lists this as a question to ask about your own policy.
Excluded causes
Flood is typically not covered by a standard policy, and water backup and earthquake are also common exclusions. Damage from an excluded cause is not paid just because it happened during a storm.
Approved, but for less than expected
A claim can be approved and still fall short. Common reasons include the deductible, depreciation under an actual cash value settlement, items missing from the insurer's estimate, or a home insured below the level the policy requires, which the Ohio Department of Insurance notes is often 80 percent of replacement cost.
What you can do next
Work through these in order. Keep copies of everything you send and receive.
- Read the denial letter and the policy language it cites. Ohio's claims-handling rule says an insurer may not deny a claim based on a specific policy provision, condition, or exclusion unless the denial refers to it. Find that section in your policy and read it in full.
- Ask for the reason in writing. If the letter is unclear, ask the insurer to explain its decision in writing. Ask to speak with a supervisor if you can't get a clear answer.
- Gather your evidence. Collect your dated photos, the storm date, your contractor's inspection findings and written estimate, and your notes from every call.
- Ask about a re-inspection. If you believe damage was missed or its cause was misjudged, ask whether the insurer will inspect again, and share your documentation.
- Check your policy for an appraisal clause. Many policies include appraisal for disagreements about the amount of a loss. Generally, you and the insurer each hire an appraiser, the two choose an umpire, and agreement by any two sets the amount. Appraisal typically settles how much, not whether something is covered, and you usually pay your own appraiser and part of the umpire's cost. Follow your policy's exact terms.
- Consider licensed help. In Ohio, a licensed public insurance adjuster can represent you in a claim for a fee, and you can consult an attorney. A contractor may not negotiate your claim for you.
- Contact the Ohio Department of Insurance. If you can't resolve it with your insurer, call ODI Consumer Services at 800-686-1526 or file a complaint online through the Complaint Center at insurance.ohio.gov.
What the Ohio Department of Insurance can and can't do
ODI suggests contacting your insurance company first, since many complaints are resolved that way. If that doesn't work, a complaint to Consumer Services should include your policy and claim numbers, a description of what happened, copies of letters between you and the insurer, and the part of your policy you believe supports your position.
According to ODI, the department reviews whether the company handled your issue within the terms of the policy and whether it broke state insurance laws or rules. ODI says it usually confirms receipt of a complaint within two weeks and that an investigation often takes about 30 days, sometimes longer. It can't act as your lawyer, resolve a dispute that comes down to your word against the company's, or force a company to pay if no law was broken.
Avoid making it worse
- Keep protecting the home from further damage while the dispute is open, and keep the receipts.
- Don't sign a contract you haven't fully read, and don't give anyone power of attorney over your claim.
- Be wary of anyone who suggests exaggerating storm damage. The Ohio Department of Insurance warns that a dishonest contractor may suggest inflating damage to get more from the insurer, and it takes fraud reports at 800-686-1527.
- Watch the deadlines in your policy, including any time limits for disputes or lawsuits.
Where a contractor fits
A contractor can't overturn a denial or negotiate with your insurer. What a contractor can do is inspect the roof, document the damage that is actually there, and give you a detailed written estimate. Our team also assists with the insurance claims process in those ways and explains what your options generally look like. If we don't see storm damage, we'll tell you.
At Blackridge, a denial starts a set process: we re-inspect the roof, then put together updated documentation for you to send to your insurer. We cannot overturn a denial, and we will not pretend otherwise, but a second set of photos and a written scope is often what was missing the first time.
This guide is general information, not legal or insurance advice, and whether a claim is covered depends on your policy and your insurance company.
Sources
- Coverage applies only if a covered peril caused the loss; typical exclusions include flood, water backup, earthquake, poor home maintenance, and building code enforcement; 80 percent of replacement cost coinsurance. insurance.ohio.gov
- Questions to ask: whether the policy covers cosmetic roof damage, how quickly to report; ACV explanation; dishonest contractors; fraud hotline 800-686-1527. insurance.ohio.gov
- Flood insurance is typically not included in a standard property policy; earthquake and water backup are not included. insurance.ohio.gov
- An insurer may not deny a claim on the grounds of a specific policy provision, condition, or exclusion unless the denial references it (OAC 3901-1-54(G)(2)). codes.ohio.gov
- Appraisal: each side hires an appraiser, they select an umpire, and any two decide the amount. iii.org
- Appraisal decides the amount of damage, not coverage; you pay your appraiser and share umpire costs (Texas regulator, general description of the appraisal process). tdi.texas.gov
- Paid negotiation of a property claim for an insured requires a public insurance adjuster license; attorneys are exempt in certain circumstances. codes.ohio.gov
- ODI complaint process: call company first, ask for supervisor and written response; Consumer Services 800-686-1526; online complaint center; required information; acknowledgment within two weeks; investigation about 30 days; what ODI cannot do. insurance.ohio.gov
- ODI Complaint Center (online complaint forms). insurance.ohio.gov
- A dishonest contractor may suggest inflating storm damage; do not give power of attorney or let a contractor negotiate or settle a claim. insurance.ohio.gov