Water Damage Claim Denied Andrew asked 3 months ago
Water Damage Claim Denied

Hi there,

I was recently denied a claim for water damage. I had found a significant amount of water in my home during a storm. The roof of my home had, within the same year, a roofer on it who proactively sealed an area with a vent. The roof was deemed sealed and safe by this professional roofer. This roof was relatively new (within the last 10 years), and has an inspection report from 3 years ago that supported that the roof was in good shape. There was no water in the home before this. In the conversations with insurance they said they don’t cover ill-maintained roofs.

My claim was denied as follows (in the insurance company’s words):

“The inspection found deteriorated and cracked sealant around the vent pipe on the roof. The inspector did not find any storm-related damage or openings in the roofing system caused by recent storms…the policy does not provide coverage for wear and tear, deterioration, faulty workmanship, or inadequate maintenance. For these reasons, we are unable to provide coverage for the damages to your property.”

We insure for sudden and accidental direct physical loss to property described in Coverages A and B except for damage caused by:

  1. Any of the following:a. Wear and tear, electrolysis, marring, deterioration;
  2. Losses excluded under General Exclusions.

GENERAL EXCLUSIONS

F. We do not insure for loss to property described in Coverages A and B caused by any of the following. However, any ensuing loss to property described in Coverages A and B not excluded or excepted in this policy is covered.

  1. a.Faulty, Inadequate or defective; b. design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction; c. materials used in repair, construction, renovation or remodeling; or d. maintenance; of part or all of any property whether on or off the residence premises.”

It seems the delineation between “deterioration” and “sudden” is blurred here. I had a sudden amount of (a lot of) water in my home and not previously, yet they have found a way to deny this claim. Any assistance to appeal this decision would be helpful.

1 Answers
Troy Willis Troy Willis Expert answered 1 month ago

Dear Andrew,

It appears that the age and material of the roof, as well as the repairs made by the roofer three years ago, are crucial factors in understanding the situation fully. Given the 20-year life expectancy of asphalt roofs and the recent repairs, it’s reasonable to question whether the roof has reached the end of its lifespan or if the denied claim is based solely on deteriorated sealant.

Since there are no photos that influenced the insurance company’s decision, it’s challenging to assess the situation accurately. Obtaining these photos and reviewing them alongside the inspection report and documentation of the repairs made by the roofer could shed light on the discrepancies between your perspective and the insurance company’s assessment.

Furthermore, understanding the specific terms and conditions of your insurance policy, particularly regarding coverage for roof maintenance and repairs, is essential in determining the validity of the denial.

In light of these considerations, it may be beneficial to request further clarification from your insurance company and provide any additional evidence or documentation that supports your claim. If necessary, seeking professional assistance from a legal or insurance expert could help navigate this complex situation and ensure a fair resolution.

I hope this helps,

Troy Willis