Your roof claim is stuck or denied: what a Richmond homeowner can do under Virginia's claim rules

We are an information site, not a roofing contractor.

First, what the rules do and do not promise

Virginia's claim-handling rules require an insurer to acknowledge that it received notice of a claim within 15 calendar days, and to give you the claim forms and instructions you need. Letters from you that call for an answer are also supposed to be answered within 15 days. Virginia regulations

Read that carefully. The 15 days is a deadline to acknowledge and to reply. It is not a deadline to pay. The sections we reviewed do not tell the insurer to finish the investigation in 15 days, and a company that has acknowledged your claim on day 10 has met that particular rule. What the rules do say is that, where liability and coverage are not in dispute, the insurer should make a fair and reasonable payment, and that it may not refuse a claim without a reasonable basis.

If the claim feels stuck

Most delays are quiet ones: nobody calls back, the adjuster visit slips, or you are told "the file is under review." Here is how to turn that into a record.

1. Write down the date you first reported the loss, how you reported it, and the name of the person you spoke with. If you reported it by phone only, send a short email or letter the same day that repeats what you reported.
2. Count 15 calendar days from the day you reported it. If you have not received an acknowledgement and the claim forms by then, say so in writing.
3. Ask a specific question in each letter. "When will an adjuster inspect the roof?" is easier to answer, and easier to prove was ignored, than "any update?" Letters that need a reply are covered by the same 15-day rule.
4. Keep every document in one folder, including photos with dates, the estimate you collected, receipts for temporary repairs and a log of every call.

Take photographs of the damage before any temporary fix such as a tarp, and keep the receipts. Whether temporary repairs are covered is a question for your policy and your insurer, so ask in writing before you spend much.

If the claim is denied

When an insurer declines a claim, Virginia's rule says it must tell you in writing and give a reasonable explanation. (Virginia Administrative Code, 14VAC5-400-70, on the same official page as the rule above.) A phone call that says "it's not covered" does not meet that standard on its own.

Once you have the letter, do three things:

• Read the reason against your policy. Find the policy language the insurer cites, and highlight it.
• Ask for what is missing. If the letter does not explain why, or does not name the policy provision, write back and ask for the specific reason and the specific wording it relied on.
• Ask what evidence it used. If an adjuster's report or an inspector's findings were part of the decision, ask for a copy, and send it along with your own photographs and any second estimate to show what you saw.

Disagreeing with a coverage decision is not the same as the insurer breaking a rule. The Bureau of Insurance can look at whether the company followed the claim-handling rules. It will not necessarily agree that your roof should be paid for.

Check the deductible before you call it a denial

Many "denied" claims turn out to be something else: the repair estimate simply came in below the deductible. Virginia allows a separate deductible for wind and hail, but no property deductible may exceed 10% of the dwelling coverage limit, and only one deductible applies to a single loss. Virginia regulations

If the wind or hail line on your policy is a percentage, the dollar amount can be large. Our guide to Virginia wind and hail deductibles shows how the arithmetic works. Also compare this year's renewal notice with last year's declarations page: Under § 38.2-2127, an insurer may change your deductible only at renewal and must give you written notice that explains how the new one applies. Code of Virginia

Why Richmond claims are often about trees

Tree canopy covered 32% of the city in 2021, down from 42% in 2014. City of Richmond Where old oaks and maples overhang older roofs, a storm claim may involve a fallen limb, a tree on the house, or a roof with years of wear underneath. Those can raise different questions under a policy, such as what caused the damage and what condition the roof was in. Describe what you saw in plain terms, such as a split rafter or missing shingles, and do not guess about the cause in writing. Leave that to the insurer's adjuster and a qualified inspector.

Who to contact in Virginia

The State Corporation Commission regulates insurance in Virginia through its Bureau of Insurance, which is in downtown Richmond at 1300 East Main Street. The state government listing gives (804) 371-9741 for the Bureau, 1-800-552-7945 as the Commission's toll-free number, and P.O. Box 1197, Richmond, VA 23218 for mail. Virginia State Corporation Commission We could not verify the Commission's website for you, so ask when you call whether there is an online complaint option and what documents to send.

Bring your claim number, the dates you reported the loss and heard back, the denial letter if you have one, and copies of your letters. Send copies and keep the originals.

If the dispute is about legal rights rather than the claim-handling rules, such as a possible lawsuit, a legal-aid office or an attorney can advise you. Central Virginia Legal Aid Society has a Richmond office at 115 S. 15th Street, Suite 400, phone 804-648-1012, open weekdays; whether it can take a case is up to the office. Central Virginia Legal Aid Society

Questions? Call (804) 764-9710 — we are a local roofing information service, not a contractor.