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Pre-Existing Condition

What is Pre-Existing Condition?

A pre-existing condition in property insurance refers to damage, deterioration, or defects that existed before the covered loss event (such as a hailstorm). Insurance policies typically exclude coverage for pre-existing damage because they only cover new damage caused by covered perils during the policy period.

In simple terms: If your roof was already damaged before the hailstorm hit, insurance won’t pay to fix the old damage—only the new storm damage.

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Table of Contents

How Insurance Companies Use Pre-Existing Condition Claims

The pre-existing condition exclusion is a legitimate policy provision, but it’s also one of the most commonly misused claim denial tactics in Colorado Springs.

Legitimate Use of Pre-Existing Exclusion

Insurance policies are designed to cover sudden, unexpected losses—not gradual deterioration or neglect.

Valid pre-existing condition examples:

  • Your roof was already leaking before the hailstorm
  • Shingles were visibly curling and failing due to age before storm damage
  • Documented previous storm damage that was never repaired
  • Severe wear and tear from normal aging unrelated to recent storm

In these cases, insurance companies rightfully distinguish between old damage (not covered) and new storm damage (covered).

Improper Use as Denial Tactic

However, insurance companies frequently claim damage is “pre-existing” when it’s actually storm-related. This happens because:

  • It’s difficult to disprove: Burden often falls on homeowner to prove damage is new
  • Saves money: Denying claims as pre-existing avoids payouts
  • Adjuster training: Some carriers train adjusters to look for pre-existing claims
  • Age-based assumptions: “Your roof is 15 years old, so this must be wear and tear”

Common improper pre-existing claims:

  • Claiming hail damage is “normal granule loss from aging”
  • Saying all damage on older roofs is automatically pre-existing
  • Attributing storm damage to “poor installation” from years ago
  • Calling fresh hail impacts “previous storm damage” with no evidence

Common Pre-Existing Condition Examples in Roof Claims

Example 1: Normal Aging vs. Storm Damage

The scenario: August 2024 hailstorm damages your 12-year-old roof.

Insurance company claim: “Your roof shows signs of normal wear and tear. The granule loss and shingle deterioration are pre-existing conditions from age, not storm damage.”

The truth: While some minor wear exists, the fresh hail impacts and concentrated granule loss in craters are clearly new storm damage. Age doesn’t make all damage pre-existing.

How to distinguish:

  • Normal aging: Uniform granule loss across entire roof, even fading, gradual curling
  • Storm damage: Random impact craters, fresh granule loss (shiny black asphalt), concentrated damage patterns

Example 2: Previous Storm Damage Claims

The scenario: Your area was hit by hail in 2022 and again in 2024. You didn’t file a claim in 2022.

Insurance company claim: “This damage is from the 2022 storm, making it pre-existing. You should have filed a claim then.”

The truth: Just because a previous storm occurred doesn’t mean all current damage is pre-existing. You may have legitimately assessed no damage in 2022, or the 2024 storm caused new damage on top of minor 2022 impacts.

Your response:

  • Professional inspection showing fresh damage patterns
  • Documentation that 2022 storm didn’t affect your neighborhood significantly
  • Evidence that damage characteristics match 2024 storm (size, direction, density)

Example 3: Installation Defects

The scenario: Hail damages your roof, but insurance finds some shingles weren’t properly nailed.

Insurance company claim: “The damage is due to improper installation, which is a pre-existing condition and not covered.”

The truth: Installation defects may be pre-existing, but hail damage on top of a poorly installed roof is still covered. Insurance must separate:

  • Covered: New hail damage (impacts, granule loss from hail)
  • Not covered: Issues caused solely by poor installation (wind blow-offs unrelated to hail)

Insurance can’t deny the entire claim because of installation issues—they must cover the storm damage portion.

Example 4: Hidden Damage Discovered During Repairs

The scenario: During tear-off, contractor finds rotted decking beneath hail-damaged shingles.

Insurance company claim: “The rotted decking is pre-existing damage from a previous leak. We won’t cover it.”

The truth: This is complicated. It depends on:

  • If hail caused the leak: Hail compromised shingles → water infiltrated → decking rotted = covered as part of storm damage chain
  • If pre-existing leak: Roof leaked before storm due to age/neglect → decking rotted before storm = not covered

Key question: Did the covered peril (hail) cause or significantly contribute to the decking damage? If yes, it should be covered.

Legitimate vs. Improper Pre-Existing Denials

Legitimate Pre-Existing Condition Denials

Insurance companies are RIGHT to deny when:

1. Documented Pre-Storm Condition

  • Previous inspection reports showing damage before storm
  • Prior insurance claims for same damage area
  • Contractor estimates obtained before storm documenting issues
  • Photos proving damage existed before loss date

2. Clear Evidence of Gradual Deterioration

  • Severe curling and brittleness consistent with age, not impact
  • Uniform granule loss across entire roof (not random impact patterns)
  • Biological growth (moss, algae) indicating long-term moisture issues
  • Wood rot clearly present for years (advanced decay, multiple areas)

3. Maintenance Neglect

  • Roof obviously beyond its useful life (25-year shingles at 30+ years)
  • Multiple missing shingles unrelated to recent storm
  • Visible deterioration from lack of maintenance
  • Failed components due to neglect, not storm

Improper Pre-Existing Condition Denials

Insurance companies are WRONG to deny when:

1. Age-Based Assumptions Without Evidence

  • Claiming all damage on roofs over 10-15 years old is automatically pre-existing
  • No actual proof damage existed before storm
  • Assumption that “old roofs can’t have new damage”
  • Denying based on age alone without inspecting actual damage characteristics

Example: “Your roof is 14 years old, so this must be wear and tear” – without examining fresh hail impacts or storm-specific damage patterns.

2. Mischaracterizing Storm Damage as Normal Wear

  • Calling concentrated granule loss from hail “normal aging”
  • Labeling fresh impact craters as “ordinary deterioration”
  • Claiming wind-lifted shingles are “failed adhesive from manufacturing”
  • Attributing new damage to vague “maintenance issues” with no specifics

3. No Supporting Documentation

  • Claiming damage is pre-existing without any proof
  • No photos, reports, or evidence showing damage existed before storm
  • Relying on adjuster opinion alone without expert analysis
  • Unable to explain how they determined damage timeline

4. Blanket Denials for Previous Storm Areas

  • Automatically denying claims because previous storms occurred in the area
  • Assuming homeowner had damage from every past storm
  • Not actually comparing damage characteristics to specific storm dates
  • Ignoring that different storms cause different damage patterns

How to Prove Damage Is NOT Pre-Existing {#how-to-prove}

Documentation You Need

1. Pre-Storm Evidence (If Available)

Most valuable but rarely available:

  • Photos of your roof taken before the storm (even casual photos showing roof in background)
  • Previous inspection reports showing roof was in good condition
  • Real estate appraisal photos if you recently purchased
  • Google Earth/Street View historical images showing roof condition

2. Storm-Specific Evidence

Proving damage matches the specific storm:

  • Weather data: Official wind speeds, hail size, storm path from NOAA or local weather stations
  • Damage characteristics: Fresh impacts, size matching reported hail, consistent patterns
  • Neighbor damage: Similar damage on nearby homes from same storm
  • Professional inspection: Roof consultant documenting fresh damage indicators

3. Fresh Damage Indicators

For hail damage:

  • Shiny, fresh asphalt exposed in impact craters (not weathered)
  • Granules displaced around impacts (not uniformly worn)
  • Random pattern matching hailstone distribution
  • Consistent impact size matching storm reports

For wind damage:

  • Broken seal strips (not gradually separated)
  • Fresh tears with no oxidation or weathering
  • Debris impact damage matching storm timing
  • Directional damage consistent with storm winds

4. Expert Analysis

Professional roof consultants can identify:

  • Age of damage based on weathering patterns
  • Difference between impact damage and deterioration
  • Storm-specific damage characteristics
  • Timeline evidence supporting new vs. old damage

Challenging Pre-Existing Condition Denials {#challenging-denials}

Step 1: Get the Denial in Writing

Request detailed written explanation including:

  • Specific reasons insurer believes damage is pre-existing
  • What evidence they’re using to support this claim
  • Photos or documentation they’re relying on
  • Policy language they’re applying

Step 2: Gather Counter-Evidence

Build your case:

  • Obtain professional roof inspection from independent consultant
  • Collect weather data for the specific storm date
  • Document fresh damage characteristics with detailed photos
  • Get written analysis explaining why damage is storm-related

Step 3: Submit Formal Dispute

Your dispute letter should include:

  • Point-by-point rebuttal of insurer’s pre-existing claim
  • Professional inspection report contradicting denial
  • Weather data supporting storm damage claim
  • Photos showing fresh damage indicators
  • Request for re-inspection by different adjuster

Step 4: Request Appraisal or Mediation

If dispute continues:

  • Appraisal clause: Neutral third-party evaluates damage (usually in your policy)
  • Department of Insurance complaint: File with Colorado Division of Insurance
  • Public adjuster: Hire professional claims advocate
  • Attorney consultation: Understand legal options if needed

Step 5: Document Everything

Throughout the process:

  • Keep copies of all correspondence
  • Document all phone calls (date, time, person, summary)
  • Save all photos, reports, and evidence
  • Maintain timeline of events

How to Prevent Pre-Existing Condition Issues {#prevention}

Proactive Measures

1. Document Your Roof’s Condition Regularly

  • Take photos from ground level every 6 months
  • Keep records of all maintenance and repairs
  • Schedule professional inspections every 3-5 years
  • Photograph roof after purchasing home

2. Address Issues Promptly

  • Fix small problems before they become big issues
  • Document all repairs with photos and receipts
  • Don’t let minor damage go unaddressed
  • Keep maintenance records organized

3. After Storm Events

  • Photograph your roof within days of major storms
  • Have professional inspection if you suspect damage
  • Document the storm date and your inspection timing
  • File claims promptly (don’t wait months)

4. Maintain Inspection Records

Keep file with:

  • Annual maintenance records
  • Professional inspection reports
  • Repair invoices and warranties
  • Photos showing roof condition over time

Real Colorado Springs Examples {#examples}

Example 1: Successful Challenge

Situation: State Farm denied 2024 hail claim as “pre-existing wear and tear” on 13-year-old roof.

Homeowner’s response:

  • Hired roof consultant who documented fresh hail impacts
  • Obtained NOAA weather data confirming 1.75″ hail on claim date
  • Provided Google Street View image from 2023 showing roof in good condition
  • Submitted detailed rebuttal with 40+ photos showing fresh damage

Result: State Farm reversed denial, approved full roof replacement ($18,500)

Key factors: Professional documentation, weather data, and pre-storm condition evidence

Example 2: Improper Denial Pattern

Situation: American Family routinely denying Colorado Springs hail claims as “previous storm damage” citing 2022 and 2023 hailstorms in area.

Reality:

  • Not every home was damaged in those storms
  • Different storms create different damage patterns
  • Homeowners with documented inspections after 2022/2023 showing no damage successfully challenged denials
  • Pattern of improper blanket denials led to Department of Insurance complaints

Outcome: Multiple homeowners successfully appealed using professional inspections showing damage characteristics matched 2024 storm, not earlier events.

Example 3: Legitimate Pre-Existing Finding

Situation: Homeowner claimed 2024 hail damage, but inspection revealed severe deterioration.

Evidence of pre-existing:

  • Extreme curling and brittleness across entire roof
  • Multiple areas of biological growth (years of development)
  • Previous contractor estimate from 2022 recommending replacement
  • Uniform granule loss inconsistent with hail pattern

Result: Denial upheld – clear evidence of pre-existing failure from age and neglect, not new storm damage.

Lesson: Not all denials are improper. Genuine pre-existing conditions exist and aren’t covered.

Common Questions {#faqs}

Can insurance deny my claim just because my roof is old?

No. Age alone is not grounds for denial. However:

  • Old roofs may have pre-existing deterioration that isn’t covered
  • New storm damage on old roofs IS still covered
  • Insurance must separate new damage from old condition
  • They can’t deny entire claim based solely on age

What if I didn’t know there was previous damage?

You’re not required to know about every minor issue. Insurance can’t claim damage is pre-existing just because you didn’t notice it. They must prove:

  • Damage actually existed before the storm
  • It was visible/discoverable with reasonable inspection
  • Current claimed damage is the same as pre-existing damage

How far back can they go to claim pre-existing?

No specific limit, but they need proof. Insurance must demonstrate:

  • When damage actually occurred
  • That it wasn’t caused by recent covered event
  • Evidence supporting their timeline claim

The older they claim damage is, the more weathering and evidence should exist.

What if they find pre-existing damage during repairs?

Hidden damage revealed during tear-off:

  • If covered event caused/contributed to hidden damage = covered
  • If hidden damage was unrelated to covered event = not covered
  • Example: Hail compromised shingles → water entered → decking rotted = covered chain of causation

Submit supplemental claim for hidden damage discovered during repairs.

Can I appeal a pre-existing denial?

Yes, absolutely. Options include:

  1. Formal written dispute with additional evidence
  2. Request different adjuster/re-inspection
  3. Invoke appraisal clause in your policy
  4. File complaint with Colorado Division of Insurance
  5. Hire public adjuster or attorney
  6. Small claims court (for smaller amounts)

Don’t accept denial without challenging if you believe it’s improper.

Related Insurance Terms {#related-terms}

Also see these glossary entries: