Claimant

What Is a Claimant?

A claimant is the person or entity who files an insurance claim seeking compensation for covered damage. In roofing insurance claims, the claimant is typically the homeowner (the policyholder) who has experienced roof damage and is requesting that their insurance company fulfill the policy’s coverage obligations.

As the claimant, you’re the party initiating the claim and advocating for fair compensation under your insurance policy. Understanding your role, rights, and responsibilities as a claimant is crucial for navigating the claims process successfully.

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Who Can Be a Claimant?

Primary Claimants

Named insured (policyholder):

• Person(s) listed on the insurance policy
• Primary homeowner
• Has direct contractual relationship with insurer
• Full rights to file and manage claims

Co-owners:

• Joint property owners listed on the policy
• Spouses or partners on the deed
• Both may need to sign claim documents
• Share claim proceeds

Example: John and Mary Smith own their home jointly. Both are named insureds on the policy. Either can initiate a claim, but both typically must sign settlement checks.

Additional Claimants

Mortgage lender (loss payee):

• Bank or lender with financial interest in property
• Named on insurance policy as mortgagee
• Must endorse insurance settlement checks
• Protects their collateral interest

Property managers (with authority):

• If granted power of attorney
• For rental or investment properties
• Must have documented authorization
• Acting on behalf of property owner

Estate representatives:

• Executors or administrators after owner’s death
• Court-appointed representatives
• Handling claims for deceased’s estate
• Requires legal documentation

HOA or condo association:

• For common area or shared roof elements
• When master policy covers certain damage
• Acting on behalf of unit owners
• Separate from individual unit owner claims

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Claimant Rights

Right to Fair Treatment

As a claimant, you’re entitled to:

Prompt acknowledgement:

• Insurer must acknowledge your claim quickly (often within 15-30 days by state law)
• Assignment of claim number and adjuster
• Clear explanation of next steps
• Reasonable timeline for investigation

Thorough investigation:

• Professional inspection of all reported damage
• Fair assessment based on actual conditions
• Consideration of all evidence you provide
• Proper evaluation of coverage provisions

Good faith handling:

• Honest evaluation of your claim
• Fair interpretation of policy language
• Reasonable settlement offers
• No intentional delay or obstruction

Clear communication:

• Plain language explanations of decisions
• Written documentation of determinations
• Responses to your questions and concerns
• Regular updates on claim status

Right to Representation

You can have representatives present:

Your roofing contractor:

• Attend adjuster inspections
• Provide technical expertise
• Explain damage severity and scope
• Offer professional opinions

Public adjuster:

• Licensed professional who works for you
• Negotiates with insurance company on your behalf
• Handles all claim documentation and communication
• Typically charges 5-15% of settlement

Attorney:

• Legal representation for disputed claims
• Particularly valuable for denials or bad faith
• Can pursue legal action if necessary
• Protects your legal interests

Important: You have the absolute right to bring any or all of these representatives to adjuster inspections or claim discussions. Insurers cannot prohibit this.

Right to Documentation

You’re entitled to receive:

Adjuster’s report:

• Damage assessment details
• Photographs taken during inspection
• Scope of work and estimates
• Coverage determinations and rationale

Claim correspondence:

• All written communications about your claim
• Emails, letters, and formal notices
• Documentation of decisions
• Timeline of claim handling

Policy provisions:

• Specific policy language affecting your claim
• Relevant endorsements or riders
• Exclusions being applied
• Coverage limits and sublimits

Settlement calculations:

• Detailed breakdown of payment amounts
• Depreciation calculations
• Deductible applications
• How final settlement was determined

Right to Appeal

If you disagree with claim decisions:

Internal appeals:

• Request reconsideration within the insurance company
• Submit additional evidence or documentation
• Request supervisor or manager review
• Follow company’s appeals procedures

Independent appraisal:

• Many policies include appraisal clauses
• Third-party evaluates disputed amounts
• Binding resolution of valuation disputes
• Does not resolve coverage disputes

State insurance department:

• File complaints with regulatory agencies
• Request investigation of unfair practices
• Seek mediation services
• Enforce consumer protection laws

Legal action:

• Hire attorney for bad faith or breach of contract
• File lawsuit if other remedies fail
• Pursue damages beyond policy limits in bad faith cases
• Last resort but sometimes necessary

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Claimant Responsibilities

Duty to Report Promptly

Timely notification requirements:

Report damage quickly:

• Most policies require “prompt” or “immediate” notification
• Specific timeframes vary (often 60 days to 1 year)
• Don’t wait until damage worsens
• Document when you discovered damage

Why prompt reporting matters:

• Connects damage to specific events
• Prevents additional damage
• Shows good faith compliance
• Preserves evidence while fresh

Example: You notice roof damage after a June hailstorm. Waiting until November to file makes it harder to prove when damage occurred and may violate policy requirements.

Duty to Mitigate Further Damage

Prevent additional loss:

Take reasonable steps:

• Tarp obvious leaks or openings
• Move valuables away from leak areas
• Place buckets under active leaks
• Arrange emergency repairs if necessary

What’s reasonable:

• Actions a prudent person would take
• Temporary measures, not permanent fixes
• Costs proportionate to preventing further loss
• Within your ability and safety

What’s not required:

• Dangerous repairs (climbing on damaged roof)
• Expensive permanent repairs before adjuster sees damage
• Professional-level repairs beyond your capability
• Anything beyond common sense protection

Document mitigation efforts:

• Photograph damage before and after temporary repairs
• Keep receipts for materials (tarps, buckets, etc.)
• Note when and how you protected property
• Submit mitigation costs for reimbursement

Duty to Cooperate

Work with the insurance company:

Provide access:

• Allow adjuster to inspect property
• Be available for scheduled inspections
• Provide entry to all damaged areas
• Enable thorough damage assessment

Provide information:

• Answer questions truthfully and completely
• Submit requested documentation
• Provide proof of loss when required
• Sign necessary claim forms

Submit documentation:

• Contractor estimates
• Repair receipts
• Maintenance records
• Photos and videos of damage

Maintain communication:

• Respond to adjuster inquiries
• Return phone calls and emails
• Meet reasonable deadlines
• Keep contact information current

Duty of Honesty

Truthful claim representation:

Honest reporting:

• Accurate description of damage
• Truthful account of when/how damage occurred
• Disclosure of pre-existing conditions
• Correct information on claim forms

No fraud or misrepresentation:

• Don’t exaggerate damage extent
• Don’t claim pre-existing damage as new
• Don’t inflate costs or losses
• Don’t submit false documentation

Consequences of dishonesty:

• Claim denial
• Policy cancellation
• Potential criminal charges
• Civil liability
• Difficulty obtaining future insurance

If you made an honest mistake:

• Correct it immediately when discovered
• Provide accurate information
• Explain the error
• Most insurers understand good faith mistakes

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Common Claimant Challenges

Disputed Coverage

When insurer denies or limits coverage:

Common disputes:

• Cosmetic vs. functional damage determinations
• Pre-existing condition arguments
• Insufficient damage claims
• Exclusion interpretations
• Coverage type disagreements

How to address:

• Request written explanation with policy citations
• Gather professional contractor opinions
• Document functional impacts of damage
• Consider independent inspection or appraisal
• File formal appeal if warranted

Undervalued Settlements

When offer seems insufficient:

Signs of undervaluation:

• Settlement significantly below contractor estimates
• Missing damage components in scope
• Unrealistic material or labor costs
• Excessive depreciation applied
• Ignored collateral damage

Steps to take:

• Get detailed written estimates from contractors
• Compare line-by-line with adjuster’s estimate
• Identify specific discrepancies
• Request supplement for missed items
• Provide documentation supporting higher costs
• Consider public adjuster for significant gaps

Communication Breakdowns

When insurer is unresponsive:

Common issues:

• Adjuster doesn’t return calls or emails
• Claim delayed without explanation
• Inconsistent information from different representatives
• Lost or misplaced documentation

How to resolve:

• Document all communication attempts
• Escalate to adjuster’s supervisor
• Send certified letters when necessary
• File complaint with state insurance department
• Maintain written record of timeline
• Consider legal counsel if delays continue

Settlement Check Issues

Problems with payment:

Mortgage company complications:

• Lender must endorse check
• May hold funds until repairs complete
• Release process can be slow
• May require multiple inspections

Incorrect amounts:

• Wrong deductible applied
• Depreciation calculated incorrectly
• Missing components or supplements
• Math errors in calculations

Payment delays:

• Processing takes longer than expected
• Additional documentation requested
• Disputes over completion verification
• Administrative errors

Solutions:

• Contact mortgage company immediately when claim filed
• Review settlement breakdown carefully before accepting
• Request corrections in writing with calculations
• Follow up persistently on payment status
• Document all delays and communications

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Multiple Claimants and Interests

Joint Owners

When multiple people own property:

Considerations:

• All owners typically must agree to settlement
• Checks usually require all signatures
• Disputes between owners can complicate claims
• May need separate legal representation

Best practices:

• Communicate with co-owners throughout process
• Agree on contractor selection together
• Both attend adjuster inspections if possible
• Coordinate on settlement acceptance

Mortgage Company Involvement

Lender as additional insured:

How it works:

• Insurance check issued to you AND mortgage company
• Lender must endorse check before you can deposit
• Lender may hold funds in escrow
• Protects lender’s collateral interest

Release of funds:

• May release in stages as work progresses
• Usually requires inspection at completion
• Some release percentage upfront
• Policies vary by lender

Process timeline:

• Can add 1-4 weeks to payment timeline
• Some lenders faster than others
• Plan for this delay in repair scheduling
• Start communication with lender early

Rental or Investment Properties

Claims on non-owner occupied properties:

Differences:

• May have different policy type (landlord/investment property policy)
• Coverage may differ from homeowner policies
• Business property considerations
• Loss of rental income coverage may apply

Claimant responsibilities:

• Property owner typically files claim
• Tenant may be involved if tenant caused damage
• Documentation of rental status important
• Separate tenant insurance for their belongings

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Claimant Mistakes to Avoid

Accepting First Offer Too Quickly

The mistake:

• Settling immediately without review
• Not comparing to independent estimates
• Feeling pressured to accept quickly
• Missing hidden or collateral damage

Why it’s problematic:

• Initial offers often conservative
• Damage discovered during repairs not covered
• Leave money on the table
• Difficult to reopen after settlement

Better approach:

• Take time to review thoroughly
• Get contractor opinion on settlement
• Consider all potential damage
• Understand you can negotiate

Not Documenting Thoroughly

The mistake:

• Relying on adjuster’s photos only
• Failing to photograph before temporary repairs
• No written records of communications
• Missing evidence of damage progression

Why it’s problematic:

• Difficult to prove extent of damage later
• Can’t support supplement requests
• Word-of-mouth harder to verify
• Weakens position in disputes

Better approach:

• Take extensive photos and videos
• Document everything in writing
• Keep copies of all correspondence
• Create timeline of events and actions

Making Permanent Repairs Before Settlement

The mistake:

• Replacing roof before adjuster inspection
• Fixing damage that hides evidence
• Starting work before approval
• Not preserving damaged materials

Why it’s problematic:

• Adjuster can’t verify original damage
• May void coverage for unverified damage
• Can’t dispute scope if evidence destroyed
• May be accused of fraud

Better approach:

• Make only temporary emergency repairs
• Document before any repairs
• Wait for adjuster inspection when possible
• Save damaged materials as evidence

Inadequate Communication

The mistake:

• Not responding to adjuster requests
• Missing deadlines without notice
• Failing to follow up on pending items
• Assuming silence means progress

Why it’s problematic:

• Can delay or derail claim
• May be interpreted as abandonment
• Weakens your position
• Can violate policy cooperation clauses

Better approach:

• Respond promptly to all requests
• Follow up regularly on status
• Keep detailed communication log
• Set reminders for deadlines

Signing Documents Without Understanding

The mistake:

• Signing releases or settlements without reading
• Not understanding what you’re agreeing to
• Rushing through paperwork
• Assuming standard documents are fine

Why it’s problematic:

• May waive rights unknowingly
• Could prevent future supplements
• Binding agreements hard to reverse
• May release claims you’re entitled to pursue

Better approach:

• Read everything before signing
• Ask questions about unclear provisions
• Have contractor or attorney review if uncertain
• Never feel pressured to sign immediately

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Working with Contractors as a Claimant

Contractor’s Support Role

How contractors help claimants:

Technical expertise:

• Identify all damage components
• Explain technical issues to adjusters
• Provide industry-standard repair methods
• Support functional damage arguments

Documentation assistance:

• Detailed estimates matching insurance format
• Professional photography of damage
• Written assessments for claim support
• Supplemental damage reports

Claims advocacy:

• Attend adjuster inspections
• Communicate directly with adjusters (when appropriate)
• Explain discrepancies in estimates
• Identify missed or underestimated items

Process guidance:

• Explain claims process steps
• Help understand settlement offers
• Assist with supplement requests
• Navigate recoverable depreciation

Red Flags in Contractor Relationships

Warning signs of problematic contractors:

Unethical practices:

• Offers to “waive” or “absorb” your deductible (insurance fraud)
• Promises to guarantee claim approval
• Pressures you to sign before settlement
• Wants you to assign insurance proceeds directly to them

Overstepping boundaries:

• Claims to be a public adjuster without license
• Demands authority to negotiate without your input
• Makes commitments on your behalf without permission
• Excludes you from communications with insurer

Poor business practices:

• No local address or established presence
• Unwilling to provide references or license
• Requires large upfront payments
• No written contract or vague terms

Appropriate contractor role:

• Provides expertise and documentation
• Supports YOUR claim, not their sale
• Respects your decision-making authority
• Professional and transparent practices

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Claimant’s Claim Timeline

Typical Process from Claimant Perspective

Week 1: Initial filing

• You discover damage and report to insurer
• Receive claim number and adjuster assignment
• Schedule inspection appointment
• Begin documenting damage

Week 2-3: Inspection and assessment

• Adjuster inspects property
• You (and contractor) point out all damage
• Adjuster prepares report and estimate
• Initial determination made

Week 3-4: Review and negotiation

• You receive settlement offer
• Compare with contractor estimates
• Request supplements if needed
• Negotiate discrepancies

Week 4-6: Settlement

• Accept final offer
• Receive initial payment (ACV)
• Sign necessary documents
• Select contractor and schedule work

Week 6-12: Repairs

• Contractor completes work
• Address any issues during construction
• File supplements for newly discovered damage
• Document completion

Week 12-14: Final payment

• Submit completion documentation
• Receive recoverable depreciation
• Obtain final releases
• Close out claim

Note: Timeline varies significantly based on claim complexity, damage extent, and whether disputes arise. Complex claims can take 6+ months.

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Questions Claimants Should Ask

Questions for Your Insurance Company

1. What is my claim number and who is my assigned adjuster?
2. What is the expected timeline for my claim?
3. What documentation do you need from me?
4. What are my rights as a claimant?
5. Can I have my contractor present during inspections?
6. How will my settlement be calculated?
7. What is the appeals process if I disagree with determinations?
8. How and when will I receive payment?

Questions for Your Adjuster

1. What damage did you identify during inspection?
2. Is all reported damage included in your assessment?
3. How did you calculate depreciation?
4. What policy provisions apply to my claim?
5. Can you explain any exclusions being applied?
6. How do I submit supplements for additional damage?
7. What is the next step in the process?
8. When can I expect a written report?

Questions for Yourself

1. Have I documented all damage thoroughly?
2. Do I understand what my settlement covers?
3. Have I compared the settlement to independent estimates?
4. Am I comfortable with the adjuster’s assessment?
5. Do I need additional professional help (public adjuster, attorney)?
6. Have I met all my responsibilities as a claimant?
7. Is the timeline reasonable given the scope?
8. Do I understand what happens next?

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State-Specific Claimant Protections

Varying Consumer Rights

State insurance regulations differ:

Claim handling timeframes:

• Some states mandate response times
• Specific deadlines for inspections
• Required payment timelines
• Penalties for violations

Unfair practices prohibitions:

• Specific banned practices by state
• Consumer protection statutes
• Bad faith claim standards
• Available remedies

Disclosure requirements:

• What insurers must tell claimants
• Required policy explanations
• Claim process notifications
• Appeal rights disclosures

Check your state insurance department website for specific claimant rights and protections in your jurisdiction.

Resources for Claimants

Where to get help:

State insurance department:

• Consumer assistance divisions
• Complaint filing processes
• Educational resources
• Mediation services

Consumer advocacy groups:

• United Policyholders
• Consumer Federation of America
• State-specific consumer organizations
• Legal aid societies

Professional organizations:

• National Association of Public Insurance Adjusters
• State bar associations (for attorney referrals)
• Better Business Bureau
• Local contractor associations

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Related Roofing Terms

• Claim: The formal request you file as a claimant
• Adjuster: Insurance professional who evaluates your claim
• Policyholder: The insured party (typically same as claimant)
• Public Adjuster: Licensed professional who represents claimants
• Settlement: The amount insurer agrees to pay to resolve claim
• Coverage: The protection you’re entitled to as a claimant
• Deductible: Amount you as claimant pay before coverage applies
• Appeal: Process to challenge claim decisions as a claimant

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Professional Claimant Advocacy

Navigating the claims process as a claimant can be overwhelming, especially when dealing with damage to your most valuable asset. As professional roof consultants, we help claimants:

• Understand their rights and responsibilities throughout the process
• Document damage thoroughly to support strong claims
• Review settlement offers for adequacy and accuracy
• Identify undervalued or missed damage components
• Communicate effectively with adjusters and insurers
• Advocate for fair treatment and proper compensation
• Navigate disputes and appeals when necessary

Need help protecting your interests as a claimant? Contact us today for a free consultation. We’ll assess your damage, review your claim status, and ensure you’re receiving the full coverage you’re entitled to under your policy.