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Insurance Claim Process: Approved/Denied: What’s Next?

Insurance Claim Process- What To Do If  Your Claim Was APPROVED or DENIED- Ultimate Wind & Hail Damage Guide For Homeowners:

Insurance Claim Process- Approved-Denied- Whats Next

 Approved claim

If, after going through the insurance claim process, the adjuster approves the claim, the he/she will write up a detailed scope of work in the form of a spreadsheet with the line items detailing the repairs that the adjuster believes your insurance company should pay to replace. Then the insurance company reviews the adjuster’s report (which includes pictures showing the hail damage), the insurance company approves the adjuster’s scope of work, and sends you and your contractor the approved scope of work along with the insurance company’s pricing.

It is the job of the QLC to be very comfortable with the insurance claim process and to review the insurance company’s approved scope of work to make sure all the legitimate damage has been approved to be repaired or replaced and that they are paying the usual and customary prices for your area. If you and the QLC agree with the scope of work and the pricing, skip the next section and go on to the next chapter.

If you and your contractor to determine that the pricing and the scope of work is not what it should be, it is the contractor’s job to go to the insurance adjuster to explain why the scope of work and the pricing needs to be adjusted. The Qualified Local Contractor will know how to argue on your behalf with well-informed opinions using scopes of work and pictures from hundreds of prior hail damage customer claims to support his/her opinion.

In the beginning of a storm, it’s not unusual for insurance companies to try to lowball pricing to save money. Your Qualified Local Contractor will use scopes of work and pricing from past customers (making sure they block out the homeowners contact information and claim number, but leaving  the insurance company’s name) to show the adjuster what the insurance company was paying in previous storms. Many times this will be enough to get the insurance adjuster to provide appropriate pricing.

If you and your contractor agree with the scope of work and the pricing, you can skip the next section and go to the next article about Getting Paid by Your Insurance Company.

Denied Claim

If, after following the proper insurance claim process, your claim is denied by the insurance adjuster after the first inspection, you need to have a serious conversation with your QLC to determine if there is enough obvious damage to successfully appeal the denied claim immediately to get a re-inspection from the insurance company. Typically the re-inspection team is much more thorough than the initial adjuster’s inspection. They will cite engineering reports specific to hail and they have a by-the-book mentality. The re-inspection team will not consider hail impact areas that may show granule loss in the future, so unless there is obvious hail damage, they will not approve the claim.

If your contractor says there is not enough obvious damage at the moment (and since it is unlikely to get a third inspection from your insurance company),I would recommend you to wait a few months for the rain to wash off any loose granules on the shingles to further expose the hail damage thus making it more likely for the re-inspection team to approve your claim since the damage is more obvious. If the QLC says there is enough obvious damage, go ahead and get a re-inspection right away.

Tip: What happens when large hail hits a shingle roof? The hail impacts the granules first then the asphalt and finally the fiberglass mat of the shingle. If the hail is big enough (golf ball size or larger), the hail impact hits are going to be obvious right after a storm. But, if the hail was a little bit smaller than golf ball size, then the damage may not be obvious right after the storm; it may take several rain storms to wash off the loosened granules to expose the damage.

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Our neighborhood has used several roofers and the last six roofs have all been done by NV Roofing. I suspect they will get all future business based on price and performance.

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