When disaster strikes and causes damage to commercial property, it can cause an immense amount of stress to the business owner. This is especially true when it comes to claims involving roof damage. Damage to the roof of a property doesn’t only impact the exterior of the building, it can also cause additional damage to the now-exposed interior. Unfortunately, these claims can be denied for a variety of reasons. Knowing what to do if an insurance company denies a commercial roof claim can help business owners understand their options and know how to move forward.
Commercial Roof Claim Denials
Insurance claims for roof damage are common with severe weather or disaster events such as hail, hurricanes, and tornadoes. While filing an insurance claim is often one of the first steps toward business owners getting back to work, the claims process isn’t so straightforward. Many claims for roof damage can be denied; some of the most common reasons for denial include:
- Unmitigated roof wear and tear
- The existence of prior roof damage
- The existence of partial roof damage
- Manufacturing defects
- The claim was filed too late
Well before any roof damage occurs, commercial policyholders should know the ins and outs of their insurance policy. Having a comprehensive understanding of the policy can help insureds understand the limitations or exclusions that may hinder the success of a claim. After a roof is damaged, the policyholder should document the damage through photo and video evidence and file a claim with the insurance carrier as soon as possible. After documenting the damage, policyholders should put up temporary coverings, such as tarps, to mitigate the damage.
Once a roof damage claim has been filed, an insurance claims adjuster will verify the claim and investigate the damage. The main role of the insurance adjuster is to carry out a detailed investigation of the claim by inspecting the damage, speaking to witnesses, and talking to the property owners. Unfortunately, these adjusters often work on behalf of and are paid by insurance companies. Thus, their primary job is to represent their employer and look out for their interests. Independent adjusters maintain a license that only allows them to work for an insurer and not for an insured. Insurance companies keep staff adjusters in-house or on contract to handle claims investigations.
Once the adjuster completes their investigation, they will then provide the policyholder with a summary of the damages and whether or not the claim is approved. If the roof damage claim is wrongly denied, the commercial policyholder should contact legal counsel to help appeal the claim with the insurance company and potentially file a lawsuit.
In some situations, an insurer will accept a claim but refuse to fully cover the damage by pointing out various minor provisions in the policy. For example, an insurance company may dispute coverage of hail or wind damage to air conditioning equipment on the roof but not coverage for the roof itself. In other situations, an insurance company may completely deny a claim based on the age of the roof, or may claim the damage is from wear and tear. Even if nothing specific is noted within the policy provisions, it isn’t unusual for an insurance company to deny a roof damage claim based on age or other similar issues.
Policyholders need to keep in mind that insurance companies are for-profit businesses. The business structure encourages carriers and adjusters to engage in bad faith practices for their own financial benefit. These bad faith tactics are used in various attempts by the insurer to abandon its obligations and responsibilities to policyholders. The insurer can refuse to pay a legitimate claim or to investigate and process a claim within a specific time.
This is especially egregious as insurance policies are legally binding contracts between the insurer and the insured. These contracts are also subject to an implied duty of good faith and fair dealing, which requires neither party to act in a way that will destroy or injure the right of the other party to receive the full benefits of the contract. Hiring an insurance coverage attorney experienced in commercial property claims will help enable your company to pursue bad faith actions in court and ensure you get the money you are entitled to in order to repair the property and get back on your feet.
Insurance Coverage Attorneys
After a roof has been damaged, a business owner may be faced with an insurance company that will attempt to deny coverage. At Raizner Slania, our insurance coverage attorneys know the tactics insurance companies use to skew the claims process for their benefit. We work to hold these companies thoroughly accountable under the policies as well as under state laws. If you are dealing with a commercial roof claim that has been denied, grossly underpaid, or delayed, we can help. Contact our office today for more information.
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