Exclusion
A provision in an insurance policy that eliminates coverage for specific risks, hazards, or types of damage. Common exclusions include flood, earthquake, and normal wear and tear.
A provision in an insurance policy that eliminates coverage for specific risks, hazards, or types of damage. Common exclusions include flood, earthquake, and normal wear and tear.
Why Exclusions Matter for Insurance Claims
Exclusions define the boundaries of what an insurance policy will and will not cover. When a claim is denied or partially denied, the insurer typically cites a specific exclusion as the reason. Understanding the exclusions in a policy is essential before filing a claim, as it helps set expectations and guides the documentation strategy. The most common exclusion cited in roofing claims is normal wear and tear, which is why establishing a clear connection between storm damage and the covered peril is critical.
Common Exclusions in Roofing Claims
In roofing claims, insurers frequently invoke exclusions for wear and tear, maintenance-related damage, cosmetic-only damage, and pre-existing conditions. Some policies include a cosmetic damage exclusion that does not cover hail dents that affect appearance but not function. Others exclude damage that results from failure to maintain the property. Contractors and adjusters should document the damage pattern in a way that clearly distinguishes storm damage from pre-existing wear.
Challenging an Exclusion-Based Denial
When a claim is denied based on an exclusion, the policyholder has options. Review the policy language carefully to determine whether the exclusion actually applies to the specific damage. Obtain an independent inspection report that documents the cause of loss. If the insurer is misapplying an exclusion, a public adjuster or attorney can help challenge the denial. Weather data, neighbor claims, and before-and-after photos are all useful evidence for disputing exclusion-based denials.
Frequently asked questions
The most common exclusions are flood, earthquake, normal wear and tear, intentional damage, neglect, insect or pest damage, mold (unless from a covered loss), and government action. Some of these can be added back with separate endorsements or policies.
Some exclusions can be removed by purchasing an endorsement that adds coverage for that specific risk. For example, water backup coverage can be added as an endorsement to cover sewer or drain backup damage, which is otherwise excluded.
The most relevant exclusions for roofing claims are wear and tear, neglect, and cosmetic damage. An insurer may argue that roof damage is from normal aging rather than a covered storm event. Thorough documentation of the storm event and damage pattern helps counter exclusion-based denials.
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