A denial letter from your insurance carrier is intimidating. It reads like the case is closed. It rarely is. Roughly 40 percent of the denied roof claims we have helped homeowners appeal have been reversed in part or in full once additional evidence was submitted. The appeal path is well-defined; carriers just count on most homeowners not taking it.
§ IWhy claims get denied in Texas
- 1"Wear and tear" determination — carrier says damage is pre-existing, not storm-related
- 2Insufficient documentation — scope inspection missed key items
- 3Damage threshold not met — carrier says repair is cheaper than replacement
- 4"Maintenance" exclusion — common rejection for older roofs
- 5Late filing — past the policy's notice or proof-of-loss window
The first three of these are appealable. The last two are harder but not always game-over.
§ IIStep 1 — Request the adjuster's scope report
You are entitled to a copy of the adjuster's written scope and photo documentation. Request it in writing. Compare what the adjuster documented against what your roofer documented. About 60 percent of denials trace to scope reports that missed clear damage your roofer photographed.
§ IIIStep 2 — Submit a supplement request
Your roofer drafts a supplement — a detailed line-item document with photos showing damage the original scope missed or undercounted. The supplement gets submitted to the carrier with a request for re-review. Most reversals happen at this step.
§ IVStep 3 — Demand appraisal
Texas policies include an appraisal clause. If the carrier and homeowner disagree on the scope after supplements, either side can invoke appraisal: each side names an independent appraiser, the two appraisers pick a third (the umpire), and the panel issues a binding scope determination. Cost: usually $1,500 to $4,000 split between the parties. Often recoverable on a successful appraisal.
§ VStep 4 — Bring in a public adjuster
Texas-licensed public adjusters work for you, not the carrier. They take 10 percent of the recovered claim as their fee. Worth it when the claim is large (over $25,000) and the carrier is digging in. Not worth it for smaller claims where the fee eats most of the recovery.
§ VIStep 5 — File a complaint with TDI
The Texas Department of Insurance accepts written complaints against carriers for bad-faith claim handling. TDI complaints do not directly force payment, but carriers respond to TDI scrutiny because regulatory action can affect their ability to write policies in Texas. Used as a last-resort lever.
