What happens if my roof insurance claim is denied?
You can request a re-adjustment, which means a second inspection of the roof, and if the claim is denied again you can use your insurance company's appeal or grievance process. Texas requires the insurer to put its reasons for rejecting a claim in writing, and those reasons tell you which route fits. A dispute over how much the damage is worth goes to the policy's appraisal clause, and you can file a complaint with the Texas Department of Insurance at any point.
The denial letter tells you what the insurer thinks it saw
Texas has rules for how fast an insurer answers a claim. Under Section 542.056 of the Texas Insurance Code, the company has to accept or reject the claim in writing within 15 business days of receiving everything it asked for. If it needs longer, it has to say why within that window, and then it has up to 45 more days. A rejection has to state the reasons.
Those reasons are where the appeal starts. The common ones on a roof are that the damage came from age or wear rather than a storm, that the hail marks are cosmetic and do not affect how the roof works, that the damage came from poor installation, or that it was reported too late. Some policies exclude cosmetic damage outright, which comes up most often on metal roofs.
Read the letter next to the policy section it cites. A denial for wear is a disagreement about what is on the roof, and that is worth a second look. A denial because the policy excludes the damage is a disagreement about the contract, and a second inspection will not change the wording.
A second inspection is the first thing to ask for
You can request a re-adjustment, where an adjuster comes back out to reassess the damage. Put the request in writing, give the date of the storm, and include any photos you took of hail on the ground, dents in the gutters or damage to cars and fences from the same day. Local storm reports from the National Weather Service can back up that hail fell at your address on that date.
The first inspection can go wrong for ordinary reasons. The adjuster may have looked at a handful of slopes after a long day of claims, missed the bruising that shows on a shingle by touch before it shows in a photo, or treated storm damage and old wear as one thing. A second visit with someone pointing at the damage is a different inspection.
If Power House inspected your roof, you can have your project manager there when the adjuster reassesses it. The project manager will point out all of the claim-related damage to the adjuster while they are both on the roof.
Appraisal settles the amount, and the Texas Department of Insurance hears complaints about conduct
If the claim is denied a second time, look into your insurance company's appeal or grievance policy. That internal review is usually the next step, and its written outcome is useful if the dispute goes further.
Every Texas residential property policy has an appraisal clause for disputes over how much a covered loss is worth. You and the insurer each hire an appraiser, the two appraisers choose an umpire, and a figure signed by any two of the three settles the amount. Appraisal decides the number. It does not decide whether the damage is covered in the first place, and each side pays its own appraiser, so it fits best when the insurer agrees there is hail damage and disagrees about how much.
A complaint to the Texas Department of Insurance fits when the problem is how the insurer is behaving: missed deadlines, no response, or a denial with no stated reason. Complaints have to be in writing, and the department takes them through its online complaint portal. For a large claim, a licensed public adjuster or an attorney who handles insurance disputes can advise on the rest. Texas licenses public adjusters, and a public adjuster is not allowed to take part in repairing the property.
An agreement with Power House is void if the claim is denied
Any agreement with Power House Roofing & Construction is contingent upon insurance approval and is void if the claim is denied. You will not be liable for any payment in that case.
That matters because a denial can leave a homeowner with a damaged roof and a signed contract at the same time. With Power House, the denial ends the agreement, and whatever you do next with the roof is your decision to make.
If you have a denial letter and want to know whether the damage on your roof supports a second look, call (817) 720-6465 to set up a free roof inspection.
Related questions
Do I owe Power House anything if my claim is denied?
No. Any agreement with Power House Roofing & Construction is contingent upon insurance approval and is void if the claim is denied, and you are not liable for any payment in that case.
Can appraisal overturn a denial that says the damage is not from hail?
Usually not. Appraisal settles the amount of a loss. A dispute over whether the damage is covered at all goes through a reinspection, the insurer's appeal process, a complaint to the Texas Department of Insurance or, as a last resort, a lawsuit.
How long do I have to challenge a denial?
Your policy sets its own time limits for appraisal and for filing suit, and they are in the conditions section. Read them as soon as the denial arrives, and for a large claim talk to an attorney before any of those dates get close.
