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roof repair clain rejected by insurance company

Insurance roof repair.

You can claim roof repairs on insurance – but for a claim to be successful, you will need a favourable assessment report from the assessor hired by your insurance company.

The insurance roof assessor looks for things that are immediately obvious as “storm related damage” to the roof first.
Things like:
• Hail damage.
• Tree damage (trees or branches falling on the roof).
• Wind damage (tiles, capping or roof sheeting blown off).

If the roof inspection by the insurance company finds none of the above, then the assessor will ‘make up’ reasons why the roof leaked. And the majority of these ‘stab-in-the-dark’ reasons will result in the following:
“…unfortunately the roof repairs are not storm related and are due to lack of roof maintenance.”

Storm damage roof repairs – the two views.

Most homeowners pay insurance on their homes every year and do not make any claims for many years. They then think that when the roof leaks and there is damage to the house, their insurance policy will cover all the costs associated with the storm repairs. Surely, if they have paid all these annual premiums – then the insurance company has the money to pay for the full claim.

An insurance company has certain obligations. Their main obligation is to their shareholders for making a profit year after year. This has a ‘double-edged sword’ effect.
A lot of their shareholders are the very homeowners who have any form of investment (like superannuation) in the share market. So, the homeowners gain every time the insurance company makes a profit.

If the insurance company pays out less than they get from premiums, they make a profit and the value of your shares grow.
… and also, if your insurance company loses money and goes ‘broke’ – you will be left uninsured. So, it is in everyone’s interest to let the insurance company keep making money.
…which means when it is your turn to make an insurance claim, the insurance company will make all efforts to limit THEIR losses – by reducing the ‘payout’ as much as possible.

So, if your roof leaks and you make a claim against the insurance company for repairs, you can expect some resistance for a full ‘payout’.

What is a storm-related roof repair?

I do not work for insurance companies.
But I deal with a lot of roof repair storm damage claims – mostly the ones that are rejected by insurance companies. And I think I have exposed the ‘un-written’ rule when the insurance company makes an assessment on your storm-related roof repair.

It goes like this…
 If there is physical damage to the roof caused by the wind, hail or any falling objects, then the roof damage is ‘directly storm related”. There will be no arguments, and the claim will be approved. If the leaking roof is not caused by any of these causes, then the roof problems are just so called ‘roof maintenance’ issues that is totally the homeowner’s responsibility.
However, water ingress into the internal parts of the house would not have happened if there was no rain/storm event. This means that water damage to the internal parts of your house is indeed “storm-related’. 

That means you will usually get your internal work repaired under your insurance claim.

The reason insurance companies avoid doing roof repairs.

Mike’s story…

It ‘bucketed down’ over the weekend and the roof leak returned with a vengeance. It was out with the towels and buckets. That was the leak that the roofer had tried a couple of times to fix.
So on Monday, Mike put in an insurance claim.
It took a few weeks to get an insurance assessor out. He was really just a builder and made a good assessment of the internal damages. When it came to the roof, he as ‘clueless’ as to why the roof leaked. But he saw the repair work that Mike’s roofer had done and (rightly) noted that the roof leaked because of maintenance issues. A proper roof should be able to withstand any rain.
This roof was not one of these.

The verdict was : Mike had to repair the roof (at his own cost) before the insurance company approved the internal repair work to the ceilings and walls (at the insurance company’s cost).

Mike had given up on his original roofer.
He got another roofer to quote for and perform the roof repair. Hoping that this time around, a proper roof repair would be carried out…
He waited for some rain.
Some minor storms came and went. No leaks.
So, he told the insurance company. And they came out and did all the internal repairs.
Then, 2 months later, the roof got a proper drenching.
It leaked at the same spot again! The ceiling and walls got a second soaking.

“Sorry.” The insurance company said when Mike made another claim. “we will refuse any ‘payout’ this time because you have not fixed your roof properly…”
The insurance company had limited their exposure.

If the insurance company had agreed to do the roof repair under the first claim, there would have been a good chance that the roof repair would not have been better that the one that Mike had organised himself.
That would have put the insurance company liable for the second repair to the roof leak. And this has the potential to loop several times…making it a very expensive case.

Insurance companies have learnt from their past mistakes – and that is why they will not tackle any roof repairs. They would rather replace a roof if their backs were against the wall.

When should an insurance claim be made for roof repairs?

So, what to do if the ceiling is leaking?
My advice to home owners is to submit an insurance claim if a storm has caused water ingress into the house and caused internal damage. A home owner will stand a good chance of insurance coverage repairing all the internal damage – since these are all the result of a storm event.

Mostly, any internal damage will be repaired by the insurance company under the claim. It is the roof repair work that is usually challenged by the insurance companies.

Some insurance companies even go as far as saying that since the leaking and subsequent damage is because the roof has not been maintained properly, the whole claim is rejected. They will not even do the repair to the internal damage! But this is quite rare.

So, if there is substantial damage to the inside of the home, a homeowner is better off making a claim and pay the excess.

However, if the internal damage is only slight staining to the ceiling, then the excess may be more than the cost of a re-paint. Armed with all the information above, a homeowner now knows that most insurance claims for the actual repair to the roof (if it is not obviously caused by storm damage) will be rejected.
Therefore it will be cheaper NOT to make a claim.

Just find a good roof repairer and get the roof fixed first. Then wait a (long) while to be confident that the roof repair is good – before repainting the ceiling.

So, what exactly is roof maintenance according to the insurance company?

It is easier to describe what is NOT roof maintenance and under these circumstances, the insurance companies will classify these as storm events:

  • Hail related events where roof damage is caused by hailstone damage;
  • winds blowing debris onto roofs and breaking roof tiles;
  • High winds blowing roof (or parts of roof) off;

… Anything else can be classified as ‘roof maintenance issues’ and give the insurance companies grounds for rejection of the claim.

Some examples of roof maintenance issues are:

  • blocked gutters;
  • rusty roof or rusty gutters;
  • blocked cracked or faulty flashings;
  • leaves and debris on roofs (see video below);

Other roofing problems that are due to faulty installation of design are also lumped into the ‘roof maintenance’ category:

What is the solution to expensive roof repairs?

It is not smart to have your insurance find out that your roof has maintenance issues. If you have any signs of roof leaks – you should get these repaired properly yourself.
Then, you should organise to have gutters and valleys cleaned out on a regular basis.
Some roofing companies will do maintenance inspections and provide a report. These reports should be taken as ‘cursory’ – since most tricky roof leaks will not be picked up by these ‘fly-by’ roof assessments.
The trick is to get in early.
Roof repairers are in high demand after big storms. It is better to catch them before the storm arrives…

14 responses to “Roof maintenance and how it affects your house insurance”

  1. kimtan says:

    thank you for the maintainence tips

  2. Jack Yuen says:

    Hi Tania,
    This is a difficult question – because you are not supposed to do anything to the asbestos roof sheeting.
    The asbestos sheets can crack. There are no replacement sheets available.
    Flashings on the asbestos roof can leak. You may be able to repair /maintain these if they are not asbestos based…
    … If the condition of the asbestos roof is ‘not good’ – the best solution is to replace it with a metal roof.

    Hope this helps,
    Jack

  3. Katherine says:

    Hi hoping someone can advise. Internal Ceiling collapsed without obvious cause (original 1970s plaster board and horsehair strapping). Assessor indicated insurance may reject due to maintenance however I’m at a loss as to how i could have prevented it. We replaced the roof a couple of years back, installed new gutters and gutter guards as well as full engineer report prior to purchasing.Aside from that I’m not sure what else we could have done. Any advice should the insurers use this excuse? Thanks

  4. Jack Yuen says:

    Hi Catherine,
    Unfortunately, every insurance policy has all the fine print (Product Disclosure Statement) that is inconsistent between different types of policies and different insurers.
    Then different assessors make their own rules.
    There is not much advice that I can give that will be of much use because of the above…

    Jack

  5. Simon Berger says:

    I’ve got a corrugated roof on the lean to part of the house with only a 2-2.5 drop so the assessor suggested I replace it with trim deck. I have a couple of questions: is the trim deck significantly heavier that the corrugated roofing? Will it require re engineering of my batons and beams? Is it expensive and how long would it take for 80 sq metres?

  6. Jack Yuen says:

    Hi Simon,
    The ‘Trimdek’ profile roofing is made with exactly the same material as the corrugated and is the same weight. Your battens and beams stay the same.
    Depending on how many guys are on the job, it will probably be a day or two to do the work.
    Hope this helps.

    Jack

  7. Anne says:

    My garage roof goes to the fence line, and my neighbours’ creeper has grown through the gutters and across my roof. To can’t access the creeper to trim it or remove it except from ontop of the roof which feels quite dangerous. I asked them to cut it back on their side and they say it is my responsibility.

  8. Jack Yuen says:

    Hi Anne,
    It is best if I do not comment on whose responsibility it is.
    If you are not comfortable with removing the creeper from your roof, you can get a gutter cleaner to do it for you.
    Also, if your garage roof is on the fence line, maybe you can put a ladder up from your neighbour’s yard and remove the creeper that way.

    Jack

  9. Trevor says:

    The insurance co says maintenance plus “hail cannot break open lead flashing” was the reason for declining my claim for hail damage (cracking open) to a small section of roof lead flashing. The damage was on the side of the house where most damage was done.

    Is their opinion valid?

    I have photos I can email to you for opinion.

  10. Jack Yuen says:

    Hi Trevor,
    In my experience, if the hailstorm had stones big enough to crack lead flashing (lead usually just suffer dents), then a large number of your roof tiles will be destroyed also.
    This does not seem to be the case,.
    I think you will have a hard job fighting your insurance company on this…

    Jack

  11. sharmin says:

    Hi Jack:
    If rainwater comes in and seeps and drips down through the roof becuase a tradie had mistakenly not pushed back roof tiles into place, do I get my home insurer to look into the damage to the roof? Or should it be the tradie’s insurer? If the tradie doesn’t want his insurer to be involved and wants to send his own ‘guy’ to assess the damage, should I accept that? Should I be hiring an independent inspector? Can my own home insurer asses the damage and chase the traide’s insurer to pay for the repairs? As you can see I don’t know where to start.

    Please advise.
    Thanks.

  12. Jack Yuen says:

    Hi Sharmin,
    In most cases of this type, the tradie did not mean to make the roof leak. He could have accidentally not pushed the tile back into place (I have seen this happen).
    The tradie should have his own insurance to cover the subsequent repairs after the leak.
    I think you should let him organise his own inspection and then let you know what the damage is and how it is going to be repaired.
    You can either agree to disagree on this.
    If you have your own home insurance, you can also lodge your own claim (but you will need to pay the excess etc…) with your insurance company.
    If your insurance company can recover funds from the tradie’s insurance company – you may not need to pay the excess etc.

    It all does get a bit complicated….

    Jack

  13. Aman says:

    Hi, i am covered by strata body corporate insurance. The roof on top of my garage is metal roof. One of sheet was bent in middle as someone might have steped and due to rusting process, it started leaking. Now th ceiling is also damaged. Now a building company has submitted the insurance claim for ceiling but the roof need repairs. I find the roof is not done properly beacuse as per manufacture guideline, the klip beams should be there at 900mm distance where as in this case its 1500mm hence someone tried to walk in middle and got the sheet bent. Few roofing companies have recommended to get the whole roof done again as 2 more sheets are bent with flashing also not done properly. Can you pls confirm if i can claim the new roof from insurance or it has to come from my pocket?

  14. Jack Yuen says:

    Hi Aman,
    The insurance companies will not cover defective building workmanship.
    You will have to pay for this.

    Jack

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