Denied insurance claims are a fact of life when working on insurance restoration roofing jobs. In the past few years, about 37% of all property insurance claims across the U.S. were denied, with some insurers denying as many as 50% of claims. This can create significant frustration for homeowners and contractors attempting to repair or replace a damaged roof. 

However, a denied roof insurance claim does not have to be the end of the story—or the end of your project. In this blog, we’ll outline four steps to address claim denials and explore how roofing software like AccuLynx can make it easier to manage the claims process. 

Step 1: Understand the denial

Why was the homeowner’s insurance claim denied? While the details of the denials can vary, some common reasons for a denied claim include:

• Insufficient evidence 
• Failing to follow proper procedure for filing a claim
• Unclear policy terms
• Disagreement over what caused the damage

To understand the issue with the homeowner’s claim, you’ll need to review the denial letter and identify the specific reasons why it was rejected. It’s also important to clarify the terms of the insurance policy, as there may have been a misunderstanding as to whether the policy covers the damage or how much of the damage will be covered. 

If the insurance claim was rejected due to a lack of evidence, you’ll need to make sure you have all the documentation required to resubmit the claim. That includes high-quality photos and videos of the damage, aerial roofing measurements, and storm damage reports. 

With the tools in AccuLynx, it’s easy to keep all this information together. Everything related to a job, including photos, documents, emails, and reports, is stored in a digital job file that can be accessed from anywhere and updated in real time. Once you have completed all the documentation you’ll need to resubmit the claim, you can use AccuLynx’s email template builder to quickly compile the information into a professional message and send it directly to the adjuster.

Step 2: Communicate effectively with the insurance adjuster

Working with the insurance adjuster can be one of the most challenging parts of a storm restoration job. Because of the differences in expertise and focus between the two industries, it can feel like adjusters and roofing contractors speak two completely different languages. As a result, miscommunications and misunderstandings frequently arise, slowing down claim approval and in some instances leading to claim denials. 

One way to improve communication with insurance adjusters is to meet with them in person. If the insurance claim is denied, or there is an issue with the documentation, you can request a reinspection of the roof. Attending this reinspection and advocating for the homeowner during the meeting can go a long way to solving communication issues and speeding up the claims process.

The tools in AccuLynx can also help you reduce miscommunication by allowing you to look back at a complete record of your correspondence with the insurance adjuster. Within the job file, using AccuLynx for job communications makes it easy to access past email messages and get notified when the adjuster responds. You can efficiently track how a claim is progressing and stay on top of any action items as they arise.

Step 3: Appeal the denial

Sometimes, the insurance company will continue to deny the claim despite being provided with new evidence or improved documentation. In this instance, the next step is to appeal the claim denial. While this won’t necessarily guarantee that the claim denial will be reversed, it is the best chance of getting the insurance company to change course and approve the claim.

To make the appeal most effective, it’s important to draft a strong appeal letter. This letter should include the evidence and policy information that supports the claim, outlined clearly and concisely, such as:

• The insurance policy number
• Photos and videos of the damage
• Inspection reports 
• Estimates and quotes for the repair costs
• Language from the insurance policy that supports claim approval

It can also be helpful to get advice from a third party who is trained to help people navigate insurance claims. Consider hiring a public adjuster or legal professional to evaluate the claim and help you determine the best way to appeal the denial. These professionals can also help you escalate the dispute if needed.

Once you’ve sent out your appeal, you can track the progress in the AccuLynx job file and set tasks to automatically inform your team members of action items related to the claim. AccuLynx allows you to collect all your third-party contacts in one place, so you can keep track of everyone associated with the insurance claim, reach out to them whenever you need, and see a complete history of your communications with them. 

Step 4: Avoid denied insurance claims with better roofing practices

In addition to managing denied insurance claims more effectively, it’s crucial for your roofing business to help homeowners avoid having their claims denied in the first place. Many claims are denied due to preventable factors, so addressing these issues early on can make a significant impact on your homeowners’ claims.

Guide homeowners through the claims process

Most homeowners are experiencing the claims process for the first time and need guidance to navigate it. Your roofing company can educate homeowners on the ins and outs of their insurance policy, what to expect from the claims process, and how to determine the extent of their coverage. AccuLynx can help streamline your insurance restoration roofing process, allowing you to gain expertise on roofing claims and help your customers achieve a better outcome for their claims.

Build credibility with insurance providers

It’s also important for you to build credibility with insurance companies. Having a good relationship with the providers that are active in your area will help you avoid miscommunication and make it easier to resolve difficulties. The Smart(er) Docs template tools in AccuLynx can help you create professional, branded documents with just a few clicks so that any claim denial evidence looks more polished, and nothing is left out. 

Set up custom workflows for efficient claim management

You can also use AccuLynx to set up a custom workflow for insurance claims that will ensure the same steps are followed every time. With the Workflow Manager, it’s easy to build a step-by-step checklist that prompts your team to gather all the important documentation, create the claim, and communicate with the adjuster. You’ll get notified as soon as a task is completed so you can make sure that the claims process is proceeding in a timely manner. 

The right software to help you navigate insurance claim denials

AccuLynx is designed to help your roofing company better manage the complexities of insurance restoration work. From documenting damage to communicating with adjusters to tracking claims to creating stronger workflows for future claims, the tools in AccuLynx make the claims process easier and allow you to support homeowners more effectively. Schedule a custom demo today to learn more.