How do I fight "no" claim?

The insurer has said "no", now what do I do?
It is important that you understand how a claim is processed. Let us use an example of a hail claim for your roof. The hail has come through your neighbourhood and there has been many homes that have suffered damage. Your next door neighbour, Bob has had an adjuster come out and has been given the go-ahead on a new roof.

Your have shingles on the ground. It seems obvious to you that there is an insurance claim and that you will be getting a new roof. You call your broker or agent and report the claim. What happens next?

The appraisal process
The adjuster for your insurance company will appoint an appraiser to inspect your property. This appraiser could be from an independent company or an in-house appraiser. Appraisers are licensed to perform their specific duties. The appraiser will come to your property and check out your roof.

What is the appraiser looking for?
The appraiser is looking for the cause of the damage. The next consideration is the condition of the property just prior to the damage. A brand new roof that has been damaged by hail will be a certain colour even after the damage has occurred. A pine shake roof that has rotted will show this rot even after damaged by the hail.

Is it fair that I don't get a new roof and my neighbour does?
If Bob's roof was in good condition just prior to the hail then Bob is likely to get his roof replaced and will only pay his deductible. If you have an old, worn-out roof then you would only get a percentage of the cost of the roof and still pay the deductible.

The insurance answer
If you dispute the ruling by the insurance company's assigned appraiser then you can hire an independent appraiser at your own cost. This can be about $300. If the findings of your appraiser are in your favour then you present this to the insurance company adjuster. The two appraisers will sit down and decide which one is in error. If the ruling is in your favour then you will get your roof fixed with a higher claims settlement.

If you have done repairs before you have your own appraiser look at the situation then it will be too late for you to fight the ruling. It is important to remember that a claim paid is supposed to take you back to just before the incident occurred. You are not to gain from the claim, just get even.

You can discuss your options of with legal counsel but the wordings in a property policy will always refer to appraisal being the basis of payment. So the lesson is not to be too quick to repair unless it is absolutely necessary to prevent further damage.