Can You File a Claim for Wear and Tear Roof Damage

What to do if your insurance company denies your claim?

Normal wear and tear is when your roof naturally begins to degrade or deteriorate as a result of age, exposure to the elements, and/or other variables like damage from individuals that may have broken tiles or shingles by improperly walking on the roof at some point. Most insurance policies have a specific exclusion for damages that occur as a result of age-related wear, tear and deterioration. Moreover, most policies have coverage terms which require that a “covered peril” (such as wind) first creates an opening in the roof by which water then travels to create the leak experienced in the interior of the property.

Property insurance typically protects against wear and tear like plumbing and roof leaks, weather-related fire, smoke, wind, water and lightning damage, and damage like a tree falling on your roof. Furthermore, crimes like vandalism and theft, as well as medical claims for injuries sustained on your property, are also commonly covered. Always be mindful, however, that your insurance may cover some weather events and not others, so always check the fine print and see exactly what’s covered.

Though property insurance generally covers hurricane damage, some might be surprised to learn that a claim against a specific type of hurricane-related damage has been denied due to it being omitted from general coverage—for example, if you live in a floodplain, rain damage may be covered, but flooding damage might not be. Always ask your insurance agent, at the time of purchasing the policy, to explain in detail what coverages the policy affords, the applicable limitations (if any), and what the applicable exclusions and/or endorsements to the policy are; e.g. does the policy carry the option to repair.

If your roof was damaged in a weather-related incident and your insurance company declines coverage due to the wear and tear exclusion, contact a lawyer immediately. An experienced attorney knows what the insurance companies don’t want you to know. They are equipped to deal with insurance companies’ lawyers and will fight to make sure you get what is due to you under your policy.

Who decides if it’s property damage or age-related wear, tear, and deterioration?

The insurance company will send an adjuster on its behalf to inspect the damage and gather evidence. Usually, that person will be responsible for either making a determination of what caused the damage themselves or making a coverage recommendation to the desk adjuster (an individual within the insurance company who would ultimately make the decision on your claim). These are the parties that will ultimately decide whether the damage is covered or excluded under the terms of the policy. 

Some homeowners and builders say that claims should be looked at by building engineers to really determine what caused the damage. Most claims are denied unless there is a clear event and documentation of an incident that happened that could have led to the problem. 

Why isn’t wear and tear covered?

Insurance companies expect you to routinely maintain your home, including the roof, and not allow it to fall into a state of disrepair or damage due to neglect on your part. This includes taking precautions to protect your home from storms or bad weather.

The reality is that the insurance industry’s business model is based on withholding payments—after all, they’re not making a profit if they’re paying for every claim they receive. Unfortunately, this can lead companies and adjusters to bend the facts or hire insurance-friendly inspectors to declare that damage is caused by wear and tear and excluded from coverage. 

This is when a lawyer comes in handy. 

If you live in Miami-Dade county and are having issues with your insurance company due to roof issues, don’t wait any longer! Don’t let insurance agents give you the runaround or exhaust yourself trying to get straight answers—contact Moises & Gross for a free case evaluation, and let them handle your insurance company on your behalf!