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There are a variety of reasons WHY an adjuster denies a roofing or siding insurance claim; they dispute the storm date, they didn’t perform a thorough inspection, there wasn’t enough damage to warrant a replacement, or maybe they felt that the roof could be repaired instead of replaced. The WHY doesn’t really make a difference. What matters is what the contractor can do about it.

Some roofing contractors and sales reps view a denied claim as the end of the road for that job, potentially missing out on thousands or even millions of dollars per year. Savvy contractors who understand what damage looks like and perform thorough inspections view a denied claim as just another minor setback and actively work to appeal a denied claim and convert it into a profitable job. 

Supplementing a denied roof or siding claim is the best way for you to bring an insurance storm claim back to life, but as Kenny Rogers used to say, “You’ve got to know when to hold ’em, Know when to fold ’em, Know when to walk away, And know when to run.”

Denied claims are more work for the contractor AND the homeowner. The denied claim supplementing process involves submitting a detailed Xactimate estimate with corresponding photo documentation and educating the homeowner on how to challenge the adjuster’s initial findings. If you don’t want to lose credibility with carriers, you should only supplement denied claims when you feel confident the house has enough damage to warrant an approval. By choosing the right denied claims to challenge, you will increase the likelihood of getting approvals, but even if you eventually lose the fight, you will likely have gained a long-term customer and even get referrals.

What Are Your Options?

When you want to convert a roofing insurance claim from a denial to a full replacement, there are six main options at your disposal: Re-inspections, Estimates, Engineer Reports, Public Adjusters, Arbitration, and engaging State Insurance Regulators.

1. REINSPECTION: A reinspection is when a homeowner requests that a different adjuster perform a second, full inspection of the property. You should come to the reinspection prepared to walk the adjuster through all the documented damage. Clearly marking damage and performing test squares can give you credibility with the adjuster but be careful and know your local adjusters; this can sometimes backfire if they want to be the ones to mark any damage found. When re-inspections are done correctly, you can expect conversion rates as high as 50%.
   
2. REQUEST AN ESTIMATE: Requesting an estimate from a 3rd party supplementing company is a great option for contractors who do not have experience challenging denied claims or lack experience writing Xactimate estimates. Having a well written Xactimate is the first step in the denied claim supplement process. During this stage, a 3rd party supplementing company will also be able to quickly look at the existing documentation and provide their professional opinion on the damage photos and the case to move forward. An honest 3rd party can save contractors time just by helping them avoid denied claims that have a low probability of approval.
3. ENGINEER REPORT: Engineer reports are another tool to challenge a denied claim. If the adjuster and contractor cannot agree on whether the damage is storm related or if there is enough damage to warrant replacement, then in most cases the homeowner may hire an engineer, at his or her expense, to inspect the property. In most cases if the engineer determines that the damage warrants replacement then the insurance company will reimburse the cost of the engineer. However, if it is determined that there is not enough damage to warrant replacement, then the homeowner will likely be out the expense of hiring the engineer.
   
4. PUBLIC ADJUSTER: Another option is to get a public adjuster involved. The public adjuster works on behalf of the homeowner to provide another expert inspection and has the ability to negotiate with the insurance carrier. It is a good idea to have a few vetted, trustworthy public adjusters ready to recommend. Public adjusters can be very expensive and typically should be a last resort as in most cases if there is valid damage on a property then any one of the other items mentioned in this post should ensure a similar outcome at a fraction of the cost.
   
5. ARBITRATION: Arbitration is the formal means to dispute a denied claim. The process involves both parties sending an arbitrator to inspect the property in question. Typically, the carrier is represented by a senior adjuster or some other highly credentialed inspector, while the contractor represents the homeowner. Remember arbitration takes time (hours and hours in most cases), time that could be spent going to find another deal instead of fighting a tough battle that distracts you from helping more clients. It is warranted in some cases however we at Elite feel that arbitration and public adjusters for that matter, have become vastly overused in our industry when a contractor’s focus should be on getting the next deal and repairing as many homes as possible. Like Kenny said…know when to fold ‘em.
6. DEPARTMENT OF INSURANCE COMPLAINT: In cases where storm damage is obvious, well-documented, and there exists a clear storm date, etc., and the carrier refuses to engage the claim in good faith, a contractor could recommend that the homeowner file a complaint with the Department of Insurance in that state. This action is not intended to change the outcome of a specific claim, but more so to level the overall playing field moving forward. This could help state regulators identify and weed out bad actors on the insurance side. 

No matter the step, denied claims require more buy-in from the homeowner. Sometimes the homeowner will not want to move forward with the claim but when they do, they often become more emotionally invested and determined to get the denied claim overturned. That’s why it’s so important for the contractor to educate their clients on the process, set expectations and communicate every step of the way. Remember it all starts with being well-trained on how to identify damage, performing an accurate thorough inspection, and only working on properties with valid damage. If you start there, your likelihood of having a denied claim overturned goes up significantly. 

When it comes to storm related insurance claims, partial approvals are going to happen. Some contractors just accept the adjuster’s initial findings and leave thousands or even millions of dollars on the table. Experienced contractors view a partial approval as part of the process and actively work to convert those initially small claims into large, profitable jobs. 

What are partial approvals and what can contractors do about them?

A partial approval is when an insurance carrier only approves replacement for part of the roof and/or siding. If the contractor feels strongly that the job requires a full replacement or additional trades, he or she can submit a partial approval supplement along with supporting documentation to attempt to get approval for a full replacement. 

Let’s say you’ve inspected a 30 square roof and found enough storm damage to warrant a claim. An adjuster may agree that a section of the roof was damaged by hail but will only approve replacement of 5 of the 30 squares. In order to get the other 25 squares approved, you need to determine if the supplement is Product Related or Damage Related. (In our experience, it’s about a 50-50 split.) Both scenarios require additional documentation. 

What type of Documentation do you need?

If the argument is Damage Related, additional damage photos and photos of test squares need to be taken and submitted along with a thorough list of accessories and components not included in the original scope of loss. (This is why you should use your inspection checklist on your inspection!) Some states even have building code requirements that limit the number of repairs that can be made on a roof, like the Florida Building Code 25% Rule. If there is a code requirement in your area, submit that, too.

If the argument is Product Related, then you need to include documentation that the shingles or siding are discontinued, unavailable, etc. ITEL reports with the receipt, letters from the supplier, or “do not mix” documentation from the manufacturer should be included with the supplement.   

How many partial approvals should you supplement?

Experienced contractors will know from the inspection if the house has sustained enough damage to warrant a claim. That, combined with proper documentation will allow you to easily know which partial approvals to focus on fighting and which ones to shift to retail jobs if the homeowner still wants a full replacement. 

Should you use a 3rd party supplementing company to process partial approval jobs?

For contractors that are inexperienced with challenging roofing and siding partial approvals or repairs, a 3rd party supplementing company can be a good option. A roofing supplement company will be able to quickly determine if enough documentation exists to move forward. 

Learn more about documentation you should use on every job on Elite’s YouTube channel.

If you’re new to the roofing business or just getting into storm restoration, you’ve likely heard the word “supplement” (or Supplement) thrown around but probably don’t have a good grasp on what it means. Let’s walk through what a supplement is and how supplementing will benefit your roofing company.

What is a supplement?

A roofing supplement or contractor supplement is when a contractor asks for additional materials, labor, or trades to be added to the insurance claim. An adjuster may not include enough shingles, ice and water shield, siding, etc. on the scope of loss to get the job done correctly. In some cases, these missing items are required by local building code. When this happens, a contractor writes a new Xactimate Estimate to include those missing items and submits it to the insurance company for approval. Contractors must also include supporting documentation such as photos, measurements, local code requirements, and invoices to explain why these funds are needed.

Why should you supplement?

Well, the simple answer is so you get paid what you deserve.

While we don’t believe the insurance company is the enemy, they sometimes make mistakes. It’s up to the contractor to find and correct those mistakes, not just for their business but also for the homeowner. Homeowners hire roofing contractors to be the expert on filing, settling, and managing insurance claims. Supplementing is a great opportunity for roofing contractors to demonstrate their expertise. When done correctly, it can improve customer service and even generate more referral leads.

How many of your jobs should you supplement?

You should review all your jobs to see if there is a need to file a supplement (there usually is). Supplementing roofing jobs is all about consistency and process. Having a standardized process for more thorough inspections makes it easier to determine if an insurance job requires a supplement and makes it easier to file one.

The best way to do this is to give your sales reps very clear rules on how ALL roof inspections are performed. Top contractors use inspection checklists and photo checklists to make sure they correctly document all of the damage and materials required to install the job. The person putting together your supplements will then compare the adjuster’s scope of loss to the inspection checklist and photos taken by the rep to see if there are any discrepancies.

While this type of process may add an additional 15-30 minutes to what your sales reps are currently doing, it will benefit your roofing business in several ways. In terms of supplementing, contractors will earn more money and get paid faster. When it comes to operations, the same process used for supplementing can also result in more accurate material orders and prevent “fire drills” like driving to a supplier to pick up materials when a crew is waiting on the roof.

How much can supplementing really make you?

At the end of the day, supplementing is like anything else – you get what you put into it. Roofing Contractors will typically earn $2,000-$6,000 per job when they supplement. That means a possible 10-25% increase in yearly revenue.

This increase in revenue means you get paid what it actually costs to do the job correctly. You spend time and money to make sure you have the right amount of material, follow local building codes, use installation best practices to comply with manufacturer warranties, etc.

Even the insurance carriers agree you should be paid for those things. But the catch is, you must ask for it. Bottom line, if you’re not taking the time to supplement, you’re losing money on every single job.

Why should you consider a 3^rd party supplementing company like Elite Claim Solutions?

It takes time to learn the intricacies of supplementing. You need to know Xactimate and Symbility, code items in your area, how to document and so on and so forth. AND you have to learn how to ask for supplements using the carrier’s language. Now, some contractors have the time, dedication, and staff to do it on their own. More power to them.

But if you’re a small roofing company or a contractor just getting into insurance restoration, you may not have the time to do it yourself. After all, storm roofing is all about sales. Anything that takes you away from sales hinders your revenue and business growth. 

You need somebody on your side who has a solid background in supplementing and gives you all the tools you need to get the supplements approved. If that is the case for your business, using a supplementing company like Elite Claim Solutions is a good option for you.

With Elite, there is no need for you to have in-depth Xactimate supplementing knowledge. We do all the heavy lifting and build honest supplement packages for you.