First: is this a denial, or a depreciated settlement?
This is not pedantry. It decides everything that follows, and the two arrive in envelopes that look almost identical.
A denial says nothing is owed. A depreciated settlement says the claim was accepted and then reduced — usually because the policy pays actual cash value on the roof rather than replacement cost. People describe both as “being denied,” because both feel like one when the check is small or absent.
| What the letter says | What it actually is | What is still open to you |
|---|---|---|
| “No covered peril” / “the loss is not covered” | A true denial. The insurer says nothing is owed | Written reasons citing the policy provision, then the escalation routes below |
| “Wear and tear” / “deterioration” / “lack of maintenance” | A true denial, resting on a carve-out from the grant rather than on the peril | The distinction between storm damage and age-related deterioration is a factual finding, and factual findings can be met with evidence |
| “Settled on an actual cash value basis” | Not a denial. The claim was accepted and depreciated | How the depreciation was calculated, and whether any of it is recoverable |
| “Payment is less than your deductible” | Not a denial. The loss was valued below your retention | The valuation itself, and whether the full scope of damage was assessed |
| “Cosmetic damage only” | Depends on your policy. Some policies carry a cosmetic damage exclusion, commonly on metal roofs | Whether that exclusion is actually on your declarations page, and whether the damage is genuinely cosmetic rather than functional |
| “Pre-existing damage” | A true denial, resting on a dating judgement | Evidence of the roof’s condition before the date of loss |
If your letter contains the phrase actual cash value, you were not denied. You were paid, less depreciation. That is a much better position to be in than it feels, because the amount of depreciation is a judgement, and there is an established process for disputing judgements about amounts.
What each stated reason actually rests on
Insurers give reasons, and the reasons are not interchangeable. Each one rests on something different, and what it rests on determines whether there is anything to address.
| Stated reason | What the insurer is asserting | What that assertion depends on |
|---|---|---|
| Wear and tear carve-out | The damage accumulated over time rather than arriving in one event | A dating judgment about the damage — and note who has to make it. The HO-3 grant for the dwelling is open-peril: “We insure against direct physical loss to property described in Coverages A and B.” “Wear and tear, marring, deterioration” sits at Perils Insured Against A.2.c.(6)(a), a carve-out from that grant rather than a separately stated exclusion. Our reading is that the insurer is the one invoking it, not you failing to prove an event |
| Roof surfacing payment schedule | Coverage applies, but the payable amount is a filed percentage set by roof age | Nothing factual, on an admitted policy. The schedule is filed with the state and applies mechanically — but only admitted carriers file. On a surplus lines policy there is no filed schedule to look up. The filed percentage itself is not arguable. The roof age recorded and the scope of what is being replaced still are — our reading |
| ACV roof endorsement | Coverage applies, less depreciation assessed on this roof | An adjuster’s assessment of age and condition — which is a judgement, and judgements can be addressed with inspection reports and maintenance records |
| Cosmetic damage exclusion | The roof is dented or marked but still performing | Whether function is genuinely unimpaired. Common on metal; some states require the exclusion be offered as an option rather than imposed — check yours |
| Failure to mitigate | Further damage occurred because the roof was not temporarily protected | What you did after the loss, and whether you kept receipts for it |
| Late reporting | The claim was not reported within the policy’s required period | When the damage was reasonably discoverable, which is not always the date of the storm |
Dropped, denied, or holding a notice you do not understand? Call us. We will read the letter with you, tell you which clock you are on and what your state requires your insurer to do — then put you in touch with a licensed agent who can quote you and write the policy.
Call (866) 754-7910Monday to Friday, 9am to 5pm ET (6am to 2pm PT). We are not an insurance agency and we do not sell policies. Call and we will help you make sense of what you have been sent — then put you in touch with a licensed agent — the one person who can actually quote you and write a policy. We hold no insurance license, so we cannot quote you, recommend an insurer, or advise you on your own policy.The appraisal clause, which most people do not know they have
Most homeowners policies contain a condition headed Appraisal. It is a contractual process for resolving a disagreement about how much a loss is worth: each side appoints an appraiser, the two appraisers select an umpire, and an agreement between any two of the three sets the amount.
It is genuinely useful and genuinely underused. It is also routinely misunderstood, in one specific way.
| The dispute | Appraisal can resolve it? | Why |
|---|---|---|
| “They say $5,000, my contractor says $28,000” | Yes | This is a valuation dispute, which is exactly what appraisal exists for |
| “They depreciated my roof too heavily” | Usually | Depreciation is part of determining actual cash value, which is an amount |
| “They say wear and tear, I say hail” | Generally no | Causation goes to coverage, not amount — though some states treat this differently, which is worth checking locally |
| “They say my policy excludes it” | No | A coverage question. Appraisal does not decide what the policy covers |
| “They applied a payment schedule” | No | On an admitted policy the percentage is filed and mechanical, and surplus lines carriers file nothing at all. Either way there is no amount in dispute to appraise |
Appraisal decides amount, not coverage. If the disagreement is whether the loss is covered at all, appraisal is the wrong instrument. If the disagreement is about how much — an insurer’s estimate set against a contractor’s — it is precisely the right one. The figures in the table above are an illustration of that kind of gap, not a benchmark for what a roof is worth.
The clause will be in your policy’s conditions section. It sets out how it is invoked, who pays for what, and any time limit that applies.
The routes available, and what each one costs
These are generally used in order, and the first two are free.
| Route | What it is | Typical cost | Where it is defined |
|---|---|---|---|
| Written reasons | A request that the insurer state the specific policy provision relied on | Free | Commonly available on request — our reading. We have not verified what every state requires, and we are not going to claim we have |
| The claim file | A request for the adjuster’s report, photographs and estimate | Free | State claim-handling rules; availability varies |
| Supplemental claim | Reopening for damage found after the original assessment | Free | Your policy; many states set a deadline for filing one |
| The appraisal clause | A contractual dispute-resolution process over the amount of loss. Each side names an appraiser; the two select an umpire. It resolves valuation, not whether the loss is covered at all | Your own appraiser, plus half of everything else. The form says each party pays its own appraiser and they “bear the other expenses of the appraisal and umpire equally” — the shared half is not just the umpire. It also runs on clocks: appraisers named within 20 days, and if no umpire is agreed within 15 days either side may ask a judge to pick one | Written into most homeowners policies. Look for the word “Appraisal” in your conditions section |
| Public adjuster | A licensed representative who handles the claim on your behalf | A percentage of the settlement — capped by statute in some states | State licensing law. Fee caps vary and should be checked before signing |
| Department of Insurance complaint | A regulator-facilitated review of how the claim was handled | Free | Your state DOI. It reviews handling and compliance, not the merits of a coverage dispute |
| Legal advice | Where coverage itself, rather than valuation, is disputed | Varies | Outside anything this page can help with |
How long the insurer has
Every state sets deadlines for acknowledging, investigating and deciding a claim. We can state Florida’s precisely because we verified it against the statute.
| Stage | Florida requirement |
|---|---|
| Acknowledging the claim | Within 7 days of receipt |
| Beginning an investigation | Within 7 days of the proof-of-loss statement |
| Physical inspection, where one is needed | Within 30 days of the proof-of-loss statement |
| Paying or denying, in whole or in part | Within 60 days of notice, subject to defined exceptions |
| Sending you a detailed estimate of the amount of the loss — you do not have to ask | Within 7 days after the estimate is generated. Note the document: it is the detailed estimate, not the adjuster's internal report. And note what the next sentence of the statute says: it “does not require that an insurer create a detailed estimate of the amount of the loss if such estimate is not reasonably necessary as part of the claim investigation”. The duty is to send one if it exists, not to produce one |
| YOUR deadline to notify a claim | Within 1 year of the date of loss. Fla. Stat. § 627.70132. Timelines published for this state usually list only the insurer's obligations, and this is the one that can end your claim |
| YOUR deadline for a supplemental claim | Within 18 months of the date of loss, same section. A supplemental claim is the route this page recommends when the first payment falls short, so this is the clock running under that advice |
| If they pay you late | § 627.70131(7)(a) provides that a payment made after the 60-day deadline bears interest at the rate set by § 55.03, and that interest “begins to accrue from the date the insurer receives notice of the claim”. That is money, and nobody will volunteer it |
| Written reasons, in Florida specifically | The same subsection requires the insurer to “provide a reasonable explanation in writing to the policyholder of the basis in the insurance policy… for the payment, denial, or partial denial of a claim”. Our escalation table below calls written reasons “commonly available on request” and labels it our reading. For Florida it is a statutory duty and we had the statute open |
For every other state, your department of insurance publishes the timeline that applies to you, and a missed deadline is something the department itself will take an interest in. We would rather send you to the authoritative source than publish a fifty-state table assembled from inference — which is what most of the tables you will find online actually are.
What actually changes an outcome
Not persuasion. Evidence, and specifically evidence that addresses the particular thing the insurer asserted.
| Evidence | Why it carries weight | When to get it |
|---|---|---|
| Dated photographs of the roof before the loss | Directly addresses both “pre-existing” and “wear and tear” | Before anything happens. Real-estate listing photos and past inspection reports often supply this after the fact |
| A roofing contractor’s written scope and estimate | Establishes what repair actually requires, line by line | Before the adjuster’s figure is treated as settled |
| An independent inspection report | Speaks to condition and remaining useful life in a form an appraiser recognizes | Ideally commissioned by you, not supplied to you |
| Maintenance and repair invoices | Rebuts “lack of maintenance” with dates | Keep them permanently, however small the job |
| Weather data for the date of loss | Corroborates that a qualifying event occurred at that location | NOAA’s Storm Events database is public and free |
| The insurer’s own photographs and report | Shows what the decision was actually based on — including whether an aerial image was used | Request it in writing |
If the decision was driven by an aerial or satellite image — which is increasingly common on roof claims — ask for it, but do not assume you are entitled to it. As at 27 August 2026 we know of two states that make it a right, and both start later: Indiana and Georgia, from 1 January 2027, require the notice to include the images or say how to get them. Elsewhere it is not a right — Maryland, for one, “encourages” insurers to share rather than requiring it. What changes the answer in practice is filing a complaint with your department: in Maine, Maryland, North Carolina and West Virginia, viewing tends to become an entitlement once you do. Our page on imagery decisions sets out every bulletin we have read. You will see it written that several states now require the insurer to hand the image over. Arguing for a right you do not have costs you the time the complaint would have taken. Tennessee’s Bulletin 25-03, updated 2 April 2026, goes further: denying a claim “based solely on unclear or imprecise aerial images that do not accurately reflect the current state of the subject property constitutes an unfair claims practice” under Tenn. Code Ann. § 56-8-105. Read both qualifiers. It is not the case that any denial touching imprecise imagery is an unfair practice — the bulletin reaches sole reliance on images that misstate the property’s current condition. And it is a regulator’s enforcement position in guidance, not a statutory bar on imagery alone. Aerial imagery is often out of date and regularly mistakes shadow, staining or algae for deterioration. An image you can see is an image you can rebut.
A note on what we are not doing here
We publish educational information. We are not an insurance agency, we do not represent you, and nothing on this page is advice about your particular claim — we have not read your policy, and your policy language is what governs.
What we can tell you is which mechanisms exist and where they are written down, so that you can find them in your own documents and ask informed questions of the people who do represent you.
Corrections to this page (7)
We publish these rather than editing quietly. Our corrections policy explains how we handle errors.
- — We told readers they have a right to the aerial image. In most states they do not. This page said “several states now require the insurer to hand the image over”. As at today we know of two — Indiana and Georgia — and both requirements start on 1 January 2027. Maryland encourages sharing rather than requiring it. What actually works, on our own reading of the bulletins, is filing a complaint with the department: in Maine, Maryland, North Carolina and West Virginia, viewing tends to become an entitlement once you do. A reader would have spent their effort asserting a right instead of taking the step that gets results. Our own imagery page, built from fourteen bulletins, already said this; this page said the opposite from one.
- — We published a months-long escalation ladder and never mentioned the limitation period underneath it. The ISO form this page quotes six times says at Section I — Conditions, H. Suit Against Us that an action must be started “within two years after the date of loss”, and that there must have been full compliance with the Section I duties. Appraisal, a public adjuster and a department complaint all take months and none of them stops that clock. We had the document open.
- — Our Florida table listed five insurer deadlines and none of the reader's own. Fla. Stat. § 627.70132 gives a policyholder one year from the date of loss to notify a claim and 18 months for a supplemental claim — and a supplemental claim is the route this page recommends when the first payment falls short. We also omitted § 627.70131(7)(a)'s interest on late payments, and its requirement that the insurer explain a denial in writing, while our escalation table called written reasons a matter of custom and labeled it our reading.
- — We said “wear and tear, marring, deterioration” appears in the policy's EXCLUSIONS section, and that the allocation was “the whole point”. It is not in that section. It sits at Perils Insured Against A.2.c.(6)(a), as a carve-out from the coverage grant. Our reading of where the burden falls is unchanged, but it is now labeled as our reading rather than as a fact about the form's layout.
- — Our Florida table said the insurer must send you a detailed estimate of the loss within 7 days. The statute's next sentence says it “does not require that an insurer create a detailed estimate of the amount of the loss if such estimate is not reasonably necessary as part of the claim investigation”. The duty is to send one if it exists.
- — We gave the cost of appraisal as “your appraiser plus half the umpire”. The form says each party pays its own appraiser and they “bear the other expenses of the appraisal and umpire equally”.
- — We said a roof payment schedule is “filed with the state” without qualification. Surplus lines insurers file neither forms nor rates, and a homeowner declined by the standard market over an old roof is the reader most likely to hold a non-admitted policy.
How we researched this
Policy mechanisms on this page — the wear and tear carve-out at Perils Insured Against A.2.c.(6)(a), actual cash value settlement, roof surfacing payment schedules, cosmetic damage exclusions and the appraisal condition — are described from the ISO Homeowners 3 — Special Form and from carrier-filed endorsements. ISO does not publish its forms, so we worked from a specimen a reader can open: HO 00 03 05 11, as filed with and published by the Maine Bureau of Insurance. Treat any page citing unnamed “standard homeowners policy forms” with no form number, edition or link as unverifiable, because it is. Your own policy language governs, editions differ, and many carriers file their own forms.
Florida’s claim-handling timeline is cited to Fla. Stat. § 627.70131 and related provisions. We have not independently verified the equivalent timelines in other states and have deliberately not published a fifty-state table. Nor have we verified public adjuster fee caps or matching-coverage requirements state by state; both are flagged in the text as things to check locally. Where we do not know, we say so rather than inferring.
State requirements on aerial and satellite imagery are cited to the issuing department’s bulletin. This area is moving quickly and should be re-checked against your own department.
This page is reviewed on a fixed schedule and after any relevant statutory change. If you find an error, our corrections policy explains how we handle it.
Sources
Every passage this page puts in quotation marks, with the document it came from, the part of that document, and the date we read it. 10 quotations from 3 documents. Follow the links and check us. Statutes are amended and pages move; if one of these is wrong or dead, our corrections policy says how we handle it.
ISO Homeowners 3 — https://www.maine.gov/pfr/insurance/themes/insurance/pdf/hanover_ins_group/citizens_ins_co_america/ho_00_03_05_11_homeowners_3_special_form.pdf
No action can be brought against us unless there has been full compliance with all of the terms under Section I of this policy and the action is started within two years after the date of loss.
ISO Homeowners 3 — Special Form, HO 00 03 05 11, as published by the Maine Bureau of Insurance — SECTION I — CONDITIONS, H. Suit Against Us. THE CLOCK UNDER THE ESCALATION LADDER. This page published a months-long sequence of remedies and quoted six other provisions of this same form without ever mentioning the limitation period Retrieved 27 August 2026.
We insure against direct physical loss to property described in Coverages A and B.
ISO Homeowners 3 — Special Form, HO 00 03 05 11, SECTION I — PERILS INSURED AGAINST, A., as filed and published by the Maine Bureau of Insurance. THE WORD 'SUDDEN' DOES NOT APPEAR IN THIS GRANT. An earlier version of this page said the policy 'covers sudden accidental physical loss', which inverted the burden on the page's central argument Retrieved 24 August 2026.
Wear and tear, marring, deterioration
ISO HO 00 03 05 11 — SECTION I, PERILS INSURED AGAINST, A.2.c.(6)(a). CORRECTED 25 Aug 2026: an earlier entry gave this as 'EXCLUSIONS/PERILS INSURED AGAINST', which is half wrong. It is NOT in SECTION I — EXCLUSIONS. That section runs A.1 Ordinance Or Law through B.3 Faulty, inadequate or defective, and wear and tear is not among them. It is a carve-out from the insuring agreement, not a separately stated exclusion — which matters, because this page argued from where the form prints the words Retrieved 25 August 2026.
bear the other expenses of the appraisal and umpire equally
ISO HO 00 03 05 11 — SECTION I, CONDITIONS, F. Appraisal. The shared half covers the other expenses of the appraisal as well as the umpire; this page said 'your appraiser plus half the umpire' Retrieved 24 August 2026.
We do not insure, however, for loss:
ISO HO 00 03 05 11 — SECTION I, PERILS INSURED AGAINST, paragraph A.2, the sentence that begins immediately after the coverage grant this page quotes as A.1. The grant was quoted stopping one word before it Retrieved 24 August 2026.
Fla. Stat. § 627.70131(7)(a) — https://www.flsenate.gov/Laws/Statutes/2025/627.70131
begins to accrue from the date the insurer receives notice of the claim
Fla. Stat. § 627.70131(7)(a) — the interest sentence. A late payment bears interest from NOTICE, not from the deadline Retrieved 27 August 2026.
for the payment, denial, or partial denial of a claim
Fla. Stat. § 627.70131(7)(a) — the tail of the same sentence. Registered separately because the page elides the words between the two halves, and an elided quotation has to have BOTH halves declared Retrieved 27 August 2026.
provide a reasonable explanation in writing to the policyholder of the basis in the insurance policy
Fla. Stat. § 627.70131(7)(a) — the written-explanation duty, quoted to the end of the phrase that carries it. Our escalation table called written reasons 'commonly available on request' and labeled it our reading; in Florida it is a statutory duty Retrieved 27 August 2026.
does not require that an insurer create a detailed estimate of the amount of the loss if such estimate is not reasonably necessary as part of the claim investigation
Fla. Stat. § 627.70131(3)(e), the SECOND sentence of the paragraph. The duty is to send an estimate if one is generated, not to produce one. This page's table read as a promise that a reader would get one Retrieved 24 August 2026.
Tennessee Dept. of Commerce & Insurance Bulletin 25-03, updated 2 April 2026 — https://www.tn.gov/content/dam/tn/commerce/documents/insurance/bulletins/UpdatedAerialImageryBulletin25-03_20260402.pdf
based solely on unclear or imprecise aerial images that do not accurately reflect the current state of the subject property constitutes an unfair claims practice
Tennessee Dept. of Commerce & Insurance Bulletin 25-03, updated 2 April 2026 — the claim-denial passage, citing Tenn. Code Ann. § 56-8-105. AN EARLIER VERSION OF THIS PAGE PARAPHRASED THIS WITHOUT 'solely' AND WITHOUT the accuracy qualifier, which told a reader that any denial touching imprecise imagery is an unfair practice. It is not Retrieved 24 August 2026.
Frequently asked questions
Can an insurer deny a roof claim just because the roof is old?
Age alone is not usually the stated reason. What age does is make an insurer more likely to attribute damage to gradual deterioration rather than to a single event, and more likely that an actual cash value endorsement or a payment schedule applies. Those are different mechanisms with different answers, so the wording of the letter matters.
What is the difference between a denied claim and an ACV settlement?
A denial says nothing is owed. An actual cash value settlement says the claim was accepted and then reduced by depreciation. If your letter mentions actual cash value, you were paid rather than denied, and the dispute available to you is about the amount of the depreciation.
Does the appraisal clause cost money?
Usually yes. The form says each party pays its own appraiser and that they “bear the other expenses of the appraisal and umpire equally” — so the shared half is the umpire plus the rest of the appraisal's costs, not the umpire alone. Your policy's appraisal condition sets out the specific arrangement, and it also runs on clocks: appraisers named within 20 days, and if no umpire is agreed within 15 days either side may ask a judge to pick one. Whether it is worth it depends on the size of the gap between the two valuations.
Can I still do anything if a roof payment schedule was applied?
On an admitted policy the percentage itself is filed with the state and applies mechanically, so there is no valuation argument to make about it. What can still be examined is whether the schedule applies to this peril at all, whether the roof's age was recorded correctly, and whether the scope of damage was fully assessed.
Should I use a public adjuster?
That is a decision only you can make, and it depends on the size of the claim and the gap in valuations. What is worth knowing before you decide: public adjusters are licensed, they are paid a percentage of the settlement, and some states cap that percentage by statute. Check your state's cap and read the contract before signing.
Does filing a complaint with my state insurance department help?
It is free and it creates a record. Departments review how a claim was handled and whether the insurer complied with claim-handling rules. They generally do not adjudicate the merits of a coverage dispute, so it works better against a process failure — a missed deadline, an unanswered request — than against a disagreement over what the policy covers.
How long do I have to reopen or supplement a roof claim?
Your policy sets a period, and many states set one too. It is commonly shorter than people expect and it varies, so check both your policy and your state department of insurance rather than assuming.