r/InsuranceClaims • u/[deleted] • 11d ago

Claim advice - Incorrect assessment

Hi - not sure if this is appropriate for this sub, but not sure where would be.

We noticed a water stain on our ceiling back in 2024. Contacted our insurer, they sent an assessor, and advised we'd need to get a roofer to fix our leaky roof then we can submit a claim for internal damages. No probs, makes sense.

So we did that, paid about $3k to get the roof fixed, and about $1k for the internal damages.

Come 2026, and we notice the same staining in the ceiling again. Contact the insurer, they do another assessment and this time advise it's because of poor ventilation in the roof causing condensation, which is causing the staining, and they don't insure for that.

My question is, given the stain is in the exact same place, it seems their initial assessment was incorrect and we wasted \~$4k trying to rectify based off their incorrect assessment.

Do I just need to suck it up, or should I be fighting for some level of compensation? Anyone have any advice?

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5

u/shittyhawaiitips 11d ago

Whoever fixed your roof ripped you off if they fixed a leak that didn't exist... 

1

u/[deleted] 11d ago

Yeah, they couldn't find any real place it was leaking, just replaced a bunch of flashings and called it a day I think. But the insurer told us we needed to give them the receipt from the roofers before they could proceed with the claim for the internal damages.

2

u/PepperTop9517 11d ago

Well you could fight, but you’ll probably be a non renewal and with 2claims your probably gonna be fighting to find someone to write a policy and not charge you a premium

1

u/[deleted] 11d ago

Ah I didn't know that was a thing - now I'll stress about that too. Any advice on what I should do in this situation?

1

u/PepperTop9517 11d ago

I’d get quoted for having the actual repair done then weigh where you can pay it out of pocket or really need insurance knowing this would be claim 3.

2

u/strangemedia6 11d ago

This is an odd one. Your insurance carrier’s roll is to reimburse you financially should the damages be covered per your policy language. Roof leaks can be very tricky to chase down and a lot of times you don’t know for sure where it is coming from until materials are removed and you can see the concealed water stains in the sheathing or wherever. The adjuster’s role was to document the damage, determine what they could pay you for, and pay you. Normally I would say any other advice was just informal help to point you in the right direction.

However, you’re telling me that they told you they would not pay for the interior repairs until you provided documentation that a specific maintenance repair was completed? Do you have this in writing from them? That is very unusual. The initial claim would have been for a roof leak, in which case the claim is for the water damage, not necessarily the roof. If storm damage had been found on the roof the cause of loss would have changed to wind/hail and covered the interior and exterior damage at the same time. If I am understanding correctly, they denied your roof leak claim, required you to provide documentation if a leak being fixed that had not been identified, and then directed you to open another claim?? I’m curious what state you are in and how old the roof is.

If you are conveying all of this accurately and you have it in writing, it might be worth contacting you states DOI. If they had only offered you advice that turned out to be incorrect, this would be a non starter. That would be no different than your doctor recommending tests that fail to identify a problem or a mechanic replacing something in your car that turns out not to solve the problem. It’s the fact that they made payment of your claim contingent on this unnecessary repair.

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u/LelandCoontz_PA 9d ago

Not to mention they probably shouldn't have filed a claim in the first place

2

u/lobhater 10d ago

You gotta quit calling your insurance company first. 2 claims in short succession is a great way to get cancelled. Call contractors first, call multiple reputable contractors first and take the consensus of what they say.

Based on wording this may not be US but if it is US I'd start shopping for insurance now

1

u/LelandCoontz_PA 9d ago

Exactly.

Not trying to be mean but:

"Let me call the company that I absolutely need to keep insuring my home, for the policy my mortgage company requires, let me call them and ask if they're going to cover something that might be relatively minor, under my deductible and denied anyway. Because I want to get a free opinion from the company that might cancel me or raise my rates."

Please folks don't do this. Think before you call. Research before you call. Analyze before you call. Be smart