Roof damage insurance claim: hail, wind and what gets paid

A hail or wind roof claim comes down to three questions: whether the damage is from the storm or from age, whether your policy pays the roof at replacement cost or at a depreciated value, and which deductible applies. Find those answers in your policy before you sign anything with a roofer.

What does the adjuster look for on a hail or wind roof claim?

The adjuster inspects the roof, writes an estimate, and separates storm damage from wear. The Nebraska Department of Insurance describes what hail does and does not leave on shingles:

• A random pattern of strike marks in various sizes.
• A “bruise” in the shingle mat that can be felt.
• Lost granules alone are not enough. The department says granule loss does not prove damage.
• Blisters are not hail. A blister does not have the bruise a hailstone leaves.

The same page says hail generally has to be about 1 1/4 inches across before it damages heavy composite or wood shake shingles, and that lightweight composite shingles may show damage from 1-inch hail.

Wear is the other half of the inspection. The Maryland Insurance Administration says homeowners policies do not cover maintenance, so damage from wear and tear or deterioration over time generally will not be paid.

The Texas Department of Insurance suggests being available for the adjuster’s visit so you can make sure they see everything.

Will the insurer repair the roof or replace it?

It depends on how much of the roof the storm damaged. Nebraska’s department says the adjuster may recommend repair or replacement, depending on the extent and nature of the damage. Maryland’s advisory says that if only a portion of the roof is damaged, the policy may cover repair of that portion only.

Two things you can do if the estimate looks short:

• Get your own bids. If roofers’ estimates come in higher than the adjuster’s, tell the adjuster. The Nebraska department says there may be differences in materials or damage that the adjuster can explain or resolve.
• Check for a cosmetic damage clause. United Policyholders, a nonprofit, says some policies limit coverage for “cosmetic” or “marring” damage. Where they do, the insurer will not pay to fully restore the home to its condition before the loss.

If you still disagree about the amount, see what to do when the offer is too low and the appraisal clause. A complaint to your state insurance department is free, but the Nebraska department says it cannot decide questions of fact such as whether hail caused the damage.

Why do some policies pay roofs at actual cash value?

Replacement cost coverage pays to repair or replace damaged property without subtracting depreciation. Actual cash value coverage pays the depreciated cost. Depreciation is the loss in value from age or wear.

One policy can use both. The NAIC, the association of state insurance regulators, says a policy may pay actual cash value on the roof and replacement cost on the rest of the home. United Policyholders adds that a chart or fine print in the policy may limit payouts based on the roof’s type or age.

The trade is price. The District of Columbia’s insurance department notes that actual cash value policies often cost less upfront but can leave you with significant out-of-pocket costs.

The Texas Department of Insurance works through a house insured for $200,000 with a 2% deductible ($4,000) and a roof that costs $10,000 to replace:

Replacement cost coverage can also start with a smaller check. The NAIC says the insurer may at first pay only the actual cash value, then pay the rest, called recoverable depreciation, once you show the work was done. There is usually a time limit. The NAIC puts it at 6 months to one year depending on state law and the policy, and Nebraska’s department says usually 180 days. Actual cash value vs replacement cost explains the two payments.

How do wind and hail deductibles work?

A deductible is the part of the claim you pay yourself. The NAIC says it can be a dollar amount or a percentage of the total amount of insurance, and that some policies have a special deductible for wind, hurricanes or other storms. Nebraska’s department says some companies charge a higher deductible for wind and hail than for other causes.

A percentage deductible is based on the insured value of the house, not on the damage. Maryland’s advisory gives an example: a wind storm does $3,000 of roof damage to a house insured for $100,000. With a $1,000 wind deductible, the insurer pays $2,000. With a 5% hurricane deductible, which is $5,000, the insurer pays nothing.

Nebraska’s department raises two points to weigh before you file. If repairs will cost less than your deductible, consider not filing. And some companies count wind and hail occurrences when deciding whether to renew a policy, even if no money was paid.

What should you watch for with door-to-door offers after a storm?

State insurance departments and the NAIC warn about the same things:

• Unsolicited inspections. Maryland’s regulator tells consumers to proceed with caution when roofing contractors offer, unasked, to inspect a roof in order to generate an insurance claim.
• Offers to cover your deductible. The Texas Department of Insurance says it is illegal in Texas for a contractor to waive your deductible or give a rebate or credit for it. Your insurer can ask for proof that you paid it.
• Pressure to sign or pay now. The Texas department advises getting more than one bid, never signing a contract with blank spaces, and not paying in full up front.
• Signing over your claim. An assignment of benefits transfers your rights under the policy and the claim to someone else, most often the contractor. The NAIC warns you may be giving up some, most or all of your rights.
• A roofer who will “handle the insurance”. In Texas, a contractor may not act as a public adjuster on a property where it is doing or may do the work. Contractor or public adjuster explains the difference.

If you have already signed, some states give you a window to cancel. In Nebraska, a contract with a residential contractor that is to be paid from insurance money can be cancelled until midnight of the third business day after signing, or after the insurer says in writing that all or part of the claim is not covered, whichever is later. Rules differ by state, and the state pages list them.

When is a public adjuster worth it on a roof claim?

A public adjuster is a licensed professional who handles the claim for you, and the NAIC notes that paying the fee is your responsibility. On a roof claim the fee can outweigh the gain. Texas, for example, caps the fee at 10% of the settlement. At 10% of the whole payout, the adjuster has to raise it by more than about 11.1% before you come out ahead.

A public adjuster also works within the policy you bought. An actual cash value roof clause or a percentage deductible is part of the contract.

The fee calculator runs the numbers for your claim, and the directory includes a license check.

What are the first steps after the storm?

1. Take photos and video of the damage.
2. Stop more damage. The NAIC suggests covering holes in the roof with a tarp and keeping all receipts.
3. Hold off on permanent repairs. The NAIC warns the company may not pay for repairs it did not authorize.
4. Report the claim as soon as you can, and ask whether a separate deductible applies for hail or wind.

How to document property damage and how to file a home insurance claim go through these steps. The claim clock shows your insurer’s deadlines by state.