A homeowner policy in California generally responds to sudden and accidental damage to the dwelling, such as wind uplift, and generally excludes wear and lack of maintenance. Your policy and your insurer decide any claim. The California Department of Insurance is the complaint route, reached through the number on insurance.ca.gov.
Key takeaways
- A homeowner policy generally responds to sudden and accidental damage, such as wind that lifts a roof section.
- A policy generally excludes gradual wear, aging and lack of maintenance, although the exact terms vary.
- Some coverages sit outside a standard policy and are added by endorsement, so the policy must be read as a whole.
- A dated record of the condition, with photographs, is the most useful thing a homeowner can keep.
- Reasonable steps to stop further damage are generally expected, and the steps taken should be recorded.
- The policy and the insurer decide the claim. The California Department of Insurance is the complaint route for a dispute.
What does a homeowner policy generally respond to on a roof?
A homeowner policy generally responds to sudden and accidental damage to the dwelling, such as damage from a windstorm that lifts or opens a roof section. The exact terms are set by the policy, and this page describes only the general pattern.
A roof claim is most often about damage that happened on a particular day. A windstorm that lifts shingles, bends flashing or drives a tree limb onto the roof is the kind of sudden event a standard policy generally responds to. The insurer looks at whether the damage was caused by a covered event and when it happened.
The word generally matters. A policy can contain limits, conditions and definitions that change the answer, and this guide does not state the terms of any particular policy. Read the declarations and the definitions of the policy you hold before assuming how a claim will be treated.
What do policies generally exclude from a roof claim?
Policies generally exclude gradual wear, aging, deterioration and damage from lack of maintenance. A roof that has cracked over many years because of sun and age is generally not covered in the same way as one damaged in a single storm.
The distinction between sudden damage and gradual wear is at the heart of most roof claims. A shingle that has dried out and cracked over years is aging, while a shingle that was torn off in one gust was damaged suddenly. The insurer usually looks for evidence of which happened.
Lack of maintenance is also commonly excluded. A roof that was not checked and whose failed flashing let water in for a long period may be treated differently from one that was sound before the event. A dated maintenance record helps show the roof's condition before the claim.
Which coverages sit outside a standard policy?
Some coverages are not part of a standard homeowner policy and are added by endorsement. Whether one applies to a roof is a question for the policy itself, and a homeowner should check the endorsement list rather than assume.
An endorsement changes the base policy for a named purpose. A homeowner who has added an endorsement, or who believes one applies, should find it in the policy documents and read its terms. A coverage that is not on the policy cannot be assumed to respond.
Ask your agent or insurer to list the endorsements on the policy in writing. That list, kept with the policy, saves a search later when a roof claim needs to be measured against the terms.
What should a homeowner photograph and keep?
Photograph the damage from the ground and, where it is safe, from the roof, with dates and labels for each area. Keep the photographs, the crew's written note, receipts for any temporary work and the dated notes of when the wind or rain began.
Photographs are most useful when they show the whole roof and the damaged area close up. Label each one with the side of the house and the date, and keep the originals on a phone or camera and copy them to a second place. A video walk around the house, narrated with the date, is also helpful.
Keep every document in one place: the policy, the endorsement list, the crew's findings, receipts for emergency work and any correspondence with the insurer. A complete file is easier to review and easier to explain than a set of papers in a drawer.
What is mitigation, and why does the insurer care?
Mitigation means taking reasonable steps to stop further damage after an event, such as covering an open section with a tarp or drying a wet area. Insurers generally expect it, and a homeowner should record each step taken and why.
A homeowner who sees water coming through a ceiling after a storm is generally expected to act to limit the damage. That can mean a bucket, a towel, moving valuables or a temporary cover on the roof. The purpose is to stop the damage growing, and the insurer will want to know what was done.
Record each mitigation step with its date, the reason for it and any receipt. A temporary cover should be noted with its position on the roof. The steps should be reasonable for the damage, and they should not be used to hide the damage before the insurer can see it.
What does an adjuster generally ask about a roof claim?
An adjuster generally asks when the damage was first seen, how it happened, what the roof looked like before the event, what has been done since, and who has inspected it. The answers are checked against the photographs and the written record.
The adjuster will usually ask for the dates of the event and of the first sighting, the cause as the homeowner understands it and any earlier repairs. A dated maintenance record, a previous inspection report or old photographs can answer these questions quickly.
The adjuster may also inspect the roof and the attic itself. A homeowner should let the adjuster see the damage before any permanent repair is made, unless a safety or water problem makes the repair urgent, and should record any repair that is made first.
What happens if the claim is denied or only partly paid?
If a claim is denied or only partly paid, ask the insurer to explain its reasoning in writing and to point to the policy terms it relies on. The homeowner can then compare that reasoning with the record and decide the next step, including a complaint.
A written explanation is the starting point for any dispute. It shows which part of the claim was refused, which policy term was relied on and what evidence the insurer used. A homeowner who does not have that explanation should ask for it before doing anything else.
If the explanation does not settle the matter, the complaint route is the California Department of Insurance. The Department does not act as a judge and does not issue binding decisions. It contacts the insurer on the complaint and asks it to respond.
Where does a homeowner take a roof claim complaint in California?
The California Department of Insurance is the regulator for insurance in the state, and it takes consumer complaints. Start an online complaint at insurance.ca.gov, or use the Request for Assistance form there, and call the number listed on insurance.ca.gov.
The Department's consumer information and complaint pages are on insurance.ca.gov. A formal complaint record is opened through the Request for Assistance form on that site, which lets the Department contact the insurer about the claim. Keep a copy of the form and any reference number you are given.
Use the telephone number that is listed on insurance.ca.gov, rather than a number taken from another source, since numbers that circulate elsewhere are not always current. The Department can explain the process and the steps that follow a complaint. Keep a record of every call and every reference number, since a complaint file is easiest to follow when the dates are complete.
Frequently asked questions
Does my policy cover wind damage to my roof?
A homeowner policy generally responds to sudden and accidental damage, such as wind that lifts a roof section. Whether your policy covers a particular loss depends on its terms, and the insurer decides the claim. Read the policy and ask the insurer to point to the terms that apply.
Will a dated photograph decide my claim?
A dated photograph is strong evidence of condition, but it does not decide a claim on its own. The insurer weighs it with the policy terms, the cause and the rest of the record. Keep the photographs with the other records.
Does an old roof make a claim harder?
A roof that has aged is generally treated differently from one damaged in a sudden event, because aging and gradual wear are commonly excluded. A dated maintenance record and an earlier inspection help show the roof's condition before the event.
Should I repair the roof before the insurer inspects it?
Water and safety come first. Stop further damage and make the roof safe, but record the damage and any repair before it is made. Tell the insurer what was done and why, and ask it what it needs to see before a permanent repair.
What if I disagree with the adjuster?
Ask the insurer to explain its position in writing and to point to the policy terms it relies on. If the disagreement is not settled, the California Department of Insurance takes complaints through insurance.ca.gov.
Who decides my claim?
Your policy and your insurer decide the claim. This guide and the roofing crew do not make that decision. The Department of Insurance is the complaint route for a dispute about how a claim was handled.
Does a roof claim have a filing deadline?
This guide does not state a deadline, because any time limit depends on the policy and on the law that applies to it, and a wrong figure would mislead you. Read the claim conditions in your policy and ask the insurer to state in writing any time limit that applies to your claim.
Do I need the insurer's approval before a permanent repair?
Safety and further damage come first, so a temporary cover or a safe repair can be made. Ask the insurer what documentation it needs before a permanent repair, and keep the record of what was done and when. The insurer's instructions on documentation are part of the claim file.
Sources
This guide is general information for San Bernardino County homeowners, not a substitute for an on-site inspection. Prices are estimates. See our disclaimer.