**HomeClaimWatch Case Study: When Insurers Refuse Roof Claims Due to “Age”—Despite Obvious Storm Damage**
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### The Story: A Homeowner’s Hailstorm Headache
In February 2024, a homeowner (Reddit username: [MrF_Ced](https://www.reddit.com/user/MrF_Ced)) turned to the [r/Insurance subreddit](https://www.reddit.com/r/Insurance/comments/1pdjsip/help_with_homeowners_insurance_claim/) after running into trouble with his homeowners insurance claim.
After a strong storm battered his area, MrF_Ced noticed visible issues with his roof. He reached out to three independent roofing contractors for inspections and estimates. The verdict from all three was clear and consistent: the roof exhibited obvious hail and wind damage significant enough to require a full replacement. However, these professionals also pointed out that the roof was not new, bearing signs of general wear and tear due to age. “File a claim,” they advised, “because storm damage is a common, covered peril under homeowners insurance.”
Following this advice, MrF_Ced promptly filed a claim with his insurer. The insurance company responded by dispatching a third-party adjuster to inspect the roof. However, instead of approving the claim, the insurer denied coverage, arguing that because the roof was aged and had pre-existing wear, they would not pay to repair or replace it. This rejection left the homeowner frustrated and uncertain about how to counter the decision—even given clear signs of storm-related damage.
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### What Went Wrong: Insurers and the “Old Roof” Excuse
This scenario highlights a common but contentious practice among insurers: denying legitimate claims by attributing damage to old age or “wear and tear,” even when a covered peril like hail or wind is plainly involved. It’s crucial to recognize that while normal aging is generally excluded from coverage, **sudden, accidental damage caused by events like hail or windstorm is typically covered by standard homeowners policies**—regardless of the roof’s age.
So, where did the process break down?
– **Blurring of Coverage Boundaries:** The insurance company overlooked—or chose to blur—the distinction between “wear and tear” (not covered) and **sudden damage from a covered event** (covered). Merely having an old roof does not disqualify a homeowner from coverage for new damage caused by a specific, verifiable event.
– **Relying on Age for Denial:** Rather than addressing the actual cause of the damage, the insurer focused on the roof’s condition pre-storm and used this as grounds for refusal. This shifts the burden unfairly onto the homeowner.
– **Potential Undervaluation by Third-Party Adjuster:** Sometimes, adjusters hired by insurance companies (or third parties) may underestimate damage or emphasize pre-existing conditions to limit payouts, especially with older roofs.
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### The Homeowner’s Rights
**Most standard HO-3 (Special Form) homeowners insurance policies** provide coverage for “sudden and accidental direct physical loss,” which generally includes storm-related damage. While wear, tear, and gradual deterioration are indeed excluded, any *new* damage attributable to a recent covered event—supported by a contractor’s or adjuster’s documentation—should be honored by the insurer.
**What rights did MrF_Ced have?**
– **Right to a Fair Investigation:** The homeowner is entitled to a thorough, unbiased inspection and claim evaluation.
– **Right to Appeal or Dispute:** If the claim is denied, the insured can request clarification, re-inspection, or a formal appeal.
– **Right to Independent Estimates:** The homeowner can—and should—submit independent reports and repair estimates from qualified contractors.
– **Right to File a Complaint:** If the insurer appears to be acting in bad faith, consumers can file complaints with their state’s Department of Insurance.
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### What Should Have Happened
1. **Clear Separation of Damage Types:** The insurance company should have differentiated between wear/tear and **fresh storm damage.** Coverage should be triggered for new damage caused by hail/wind, even if some older deterioration exists.
2. **Detailed Documentation:** The homeowner should provide all documentation from the contractors, noting exactly which parts of the damage are due to the storm versus prior conditions.
3. **Request for Second Inspection:** If denied, the homeowner may ask for an internal re-inspection by a company-employed adjuster or bring in a public adjuster for a truly independent assessment.
4. **Leveraging State Regulators:** If the insurer remains uncooperative, filing a complaint with the state insurance regulator can prompt a fairer review.
5. **Consulting a Public Adjuster or Attorney:** Professionals who represent policyholders can push back against unreasonable claim denials and ensure policy language is followed.
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### Lessons for Homeowners
– **Don’t Take “Old Roof” for an Answer:** Insurers cannot deny all storm claims based on age alone. Damage from covered events must be adequately evaluated.
– **Document Everything:** Get multiple written estimates from licensed roofers that specifically attribute portions of the damage to the recent storm.
– **Know Your Policy:** Read (and save!) your policy’s coverage and exclusions sections. Most policies will include wind and hail—verify if your state allows special roof age exclusions or depreciation clauses.
– **Push Back and Escalate:** If denied, request written explanations and don’t give up after the first “no.” Utilize your rights to appeal or involve the insurance department.
– **Consider a Public Adjuster:** These licensed professionals work on your behalf and can often get a fairer settlement, especially in complex or contentious cases.
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### Conclusion
MrF_Ced’s experience is, unfortunately, common—insurers sometimes use the age of a roof as a pretext to deny coverage, even for clearly covered storm events. Homeowners should be proactive, assertive, and well-informed. By understanding your rights, thoroughly documenting damage, and pushing for fair treatment, you can avoid being shortchanged when you need your insurance most.
For more on this case, see the original story on [Reddit](https://www.reddit.com/r/Insurance/comments/1pdjsip/help_with_homeowners_insurance_claim/).
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*HomeClaimWatch: Empowering Homeowners—One Case Study at a Time.*
Source: Reddit