Mrs. Close, 93, lives alone in the home she and her late husband built together. After he passed, maintaining the property became challenging—he’d always handled contractors, repairs, and insurance matters.
When a severe hailstorm damaged her roof in 2023, she filed a claim with American Family. The adjuster approved the shingle replacement but denied coverage for $10,000 in rotted decking, classifying it as “pre-existing condition” rather than storm-related damage.
On a fixed income, Mrs. Close couldn’t afford an unexpected $10,000 expense. Her late husband had carefully saved that money to secure her future. She needed someone who understood American Family’s policies and could challenge the denial.
TheThe Challenge
American Family’s Position
The adjuster claimed the rotted decking existed before the hailstorm and wasn’t covered under the storm damage claim. Initial settlement: shingles only, no decking replacement.
The Homeowner’s Reality
- $10,000 out-of-pocket expense she couldn’t afford
- Confusion about policy coverage and appeal process
- Multiple family members trying to help but unsure how to proceed
- Time pressure with Colorado weather and an exposed roof
What Was at Stake
Mrs. Close’s late husband had saved carefully to ensure she’d be financially secure. Spending $10,000 on denied coverage would deplete those savings and leave her vulnerable to future expenses.
The Strategy
Carrier-Specific Knowledge Applied
American Family’s policies include provisions for “discovered damage during covered repairs.” If damage is found during a storm-related repair that’s directly connected to the storm event—or if the storm revealed previously hidden damage—coverage can be extended.
Most homeowners don’t know this provision exists. Most contractors don’t know how to document it properly for American Family’s review process.
What We Did
1. Comprehensive Documentation
- Conducted detailed inspection of both storm damage and decking conditions
- Photographed the relationship between hail impact points and deck deterioration
- Documented how water infiltration from storm damage accelerated rot
- Created professional Xactimate report separating storm damage from underlying issues
2. Built the Case for Coverage
- Referenced specific American Family policy provisions regarding “causation vs. pre-existing”
- Provided technical analysis showing storm event’s role in exposing/worsening decking issues
- Demonstrated why decking replacement was necessary to properly repair storm damage
- Submitted supplemental documentation with professional photography
3. Coordinated Family Communication Mrs. Close had multiple family members involved in the process. We held a family meeting to explain:
- American Family’s denial reasoning
- Why we believed coverage should be extended
- What the appeal process would involve
- Timeline expectations and next steps
This ensured everyone understood the situation and reduced confusion during the claims process.
4. Persistent Advocacy Through American Family’s Review Process When American Family initially resisted, we escalated through their internal review process with additional documentation and technical analysis. We didn’t accept the first denial.
The Results
✅ $10,000 in decking coverage approved by American Family
✅ Zero out-of-pocket costs for Mrs. Close
✅ Denial overturned within 30 days
✅ Full roof replacement completed before next rain event
✅ Late husband’s savings preserved
Project Execution
Once American Family approved the full claim, we expedited the schedule to complete work before expected rain. The crew worked efficiently against the clock to protect the home.
We also connected Mrs. Close with quality gutter replacement contractors to address secondary storm damage, ensuring the entire property was properly restored.
What the Family Says
Linda Parker,
Homeowners Daughter
Why This Case Matters
Insurance Companies Count on Homeowners Not Knowing Policy Provisions
American Family’s “discovered damage” provisions exist, but adjusters don’t advertise them. Without carrier-specific knowledge, Mrs. Close would have paid $10,000 out of pocket or left her roof vulnerable.
Older Homeowners Face Unique Challenges
When the person who always handled contractors and insurance is gone, navigating complex claims becomes overwhelming. Professional advocacy removes that burden and protects against costly mistakes.
Family Coordination Matters
Multiple well-meaning family members can create confusion during claims. Clear communication and a single point of contact for the insurance company streamlines the process and reduces stress.
Persistence Overcomes Initial Denials
American Family denied the decking coverage initially. With proper documentation and escalation through their review process, that denial was overturned. Most homeowners give up after the first “no.”
Key Takeaways for Colorado Springs Homeowners
If your insurance company denies coverage for damage discovered during storm repairs:
- Understand your carrier’s “discovered damage” provisions — American Family, State Farm, Allstate, USAA, and other carriers have different policies
- Document the relationship between storm events and discovered issues — Causation matters for coverage decisions
- Don’t accept the first denial — Internal review processes exist for a reason
- Get carrier-specific expertise — Generic roofing knowledge isn’t enough for complex claims
Facing a Similar Situation?
Whether you’re dealing with:
- Denied coverage for damage discovered during repairs
- Confusion about what your policy actually covers
- An older homeowner navigating claims alone
- Multiple family members trying to help but unsure how
Professional claim advocacy can make the difference between paying out of pocket and getting full coverage.
📞 Call to discuss your claim: (719) 210-8699
📧 Email: gerald@winik.io
Schedule Your Consultation | View More Case Studies
