A letter saying your roof claim was denied, or a check far smaller than your roofer’s estimate, is a hard thing to open after a hail storm. If you have a roof insurance claim denied in Texas, the insurer must explain why in writing, and a denial is not always the end of the claim. What happens next depends on your policy, your paperwork and your deadlines.
This guide sets out what the Texas Department of Insurance says about denied and underpaid claims, how appraisal works, what a claims history report shows, and what a Texas statute says about notice before a lawsuit. It is general information, not legal advice. Your policy and your insurer decide your claim.
Why does a roof insurance claim get denied in Texas?
The Texas Department of Insurance (TDI) says the most common reason companies deny claims is that the policy does not pay for that type of damage. A claim can also close with no payment when the damage costs less than your deductible. Your written denial should tell you which reason applies to you.
TDI’s page on why a home insurance claim might be denied or not paid gives flooding and rodent or insect damage as examples of damage most policies do not cover. If the policy does not cover the damage, the company denies the claim.
The second reason is arithmetic. TDI explains that a company might close a claim without paying anything if the damage was less than the deductible. In TDI’s example, if the cost to fix your house is $5,000 and your deductible is $10,000, the company will not pay the claim. TDI notes that your deductible is on your policy’s declarations page.
If you are not sure how a percentage deductible turns into a dollar figure, our guide to wind and hail deductibles in Texas explains how to read one. Depreciation is a separate question, covered in our guide to ACV vs RCV roof coverage.
What should the denial letter tell you?
TDI says the insurance company must tell you in writing why it denied a claim. If you only got a phone call, or the reason is unclear, ask the company for the reason. Every next step starts from the reason the insurer gives you.
Keep that letter with your policy, the adjuster’s estimate and your own photos.
When the letter arrives, note:
- The reason given: coverage (the type of damage), amount (under the deductible), or something else.
- The policy wording it relies on, then find that section in your own policy.
- The estimate behind it. If you do not have it, ask for it.
- Any deadline it mentions, written on your calendar the same day.
If anything is unclear, ask your insurer to explain it in writing, and confirm every detail with your insurer.
How long does an insurer have to decide your claim?
TDI says your company has 15 business days to say it got your claim, then 15 business days after getting everything it needs from you to say whether it will pay. It can extend that by 45 days if it tells you why. Once it agrees to pay, TDI says it must pay within five business days.
Those deadlines come from TDI’s claim steps page. The same page notes that TDI can extend them by 15 more days after a weather-related catastrophe, which matters in North Texas, where one hail storm can produce many claims at once. Ask your insurer which dates apply to your claim.
Can you ask the insurer to look at the roof again?
Yes. TDI says that if you disagree with the adjuster’s final estimate, tell the company why. The company may have overlooked something and may make adjustments. TDI advises sending supporting documents, such as a contractor’s estimate for the repairs, with your request. That is the usual first step.
TDI’s page on what to do if insurance is not paying enough describes this as the starting point before appraisal, a complaint or court. TDI does not set out a formal re-inspection procedure for homeowners policies, so ask your insurer how it handles a request for a second look at the roof.
A request is stronger when it is specific. Build it around:
- Photos and video of the damage, taken as soon as it was safe, as TDI’s hail damage page recommends.
- A written contractor’s estimate that lists the items and quantities, so the insurer can compare it line by line.
- Items missing from the adjuster’s estimate, named one by one.
Nothing here involves climbing onto the roof. Photos from the ground or a window are enough for your records. Our guide on how to choose a roofing contractor in Plano covers how to check who you let up there.
How does the appraisal clause work for a roof claim?
TDI says your policy may include an appraisal process. You and the company each hire an appraiser, and the two choose a third as the umpire. If their estimates differ, the umpire makes the final decision, which TDI says is binding on both of you. Check your policy for appraisal deadlines.
The steps as TDI describes them on its disagreement page:
- You and the insurance company each hire an appraiser.
- The two appraisers choose a third appraiser to act as the umpire.
- Your appraiser and the company’s appraiser each make their own estimate of your loss.
- If the estimates are different, the umpire makes the final decision.
- That decision is binding on both you and the company.
TDI also says you pay the expenses of the appraiser you hire and half of the umpire’s expenses.
Three cautions follow from TDI’s own wording. First, the policy “may” include appraisal, so read yours before you assume it does. Second, appraisal has deadlines set by the policy, and TDI tells you to check them. Third, a binding decision cuts both ways. Ask your insurer, in writing, whether your policy has an appraisal clause and what its deadline is.
What else can you do if you still disagree?
TDI lists several options after you have told the company why you disagree. You can request appraisal if your policy has it, file a complaint with TDI, ask for alternative dispute resolution through mediation, or sue the insurance company in court. TDI points people to resources to find legal help. Which route fits depends on your claim.
The options TDI names, side by side:
| Option | What TDI says it is | Worth knowing |
|---|---|---|
| Tell the company why | Send your reasons and supporting documents | The company may have overlooked something |
| Appraisal | Two appraisers and an umpire settle the amount of the loss | Only if your policy includes it; binding |
| Complaint to TDI | TDI can ask the company to relook at the policy | For when you think you were treated unfairly |
| Mediation | Alternative dispute resolution with a neutral third party | Settles disputes outside court |
| Lawsuit | You have the right to sue the insurance company | Talk to an attorney first |
On complaints, TDI’s denied claim page says that if you think your insurer unfairly denied your claim, you can file a complaint, and TDI can ask a company to relook at the policy to be sure it made the correct decision.
What does Texas Insurance Code chapter 542A say about suing over a storm claim?
Chapter 542A of the Texas Insurance Code covers certain lawsuits over property damage claims caused by forces of nature, which the text says include hail, wind and rainstorms. It requires written notice before filing suit and gives the insurer a right to ask to inspect the property. Talk to an attorney before relying on any of it.
The points below are only what the text of chapter 542A says, without its conditions and exceptions, so talk to an attorney before acting on any of them.
Which claims it covers. The chapter defines a claim as a first-party claim under a policy covering real property, paid by the insurer directly to the insured, arising from damage caused wholly or partly by forces of nature, and it lists hail, wind and rainstorms among them. It states that it does not apply to an action against the Texas Windstorm Insurance Association. Whether your claim falls inside it is a legal question, so talk to an attorney.
Notice before a lawsuit. Section 542A.003 says that, as a prerequisite to filing suit, the claimant must give written notice not later than the 61st day before filing. The text says the notice must state the acts or omissions giving rise to the claim, the specific amount alleged to be owed, and the attorney’s fees incurred, calculated as the section describes. The section also lists situations where notice is not required. Talk to an attorney about whether and how notice applies to you.
The insurer’s right to inspect. Section 542A.004 says that within 30 days of receiving the notice, the person notified may send a written request to inspect, photograph or evaluate the property in a reasonable manner and at a reasonable time. It says that, if reasonably possible, the inspection must be completed within 60 days of receiving the notice. Talk to an attorney before you respond to an inspection request.
Abatement. Section 542A.005 says that, on a plea in abatement, a court shall abate the action if the defendant did not receive a complying notice, or asked to inspect and was not given a reasonable opportunity. Talk to an attorney about what that means for timing.
Attorney’s fees. Section 542A.007 links the attorney’s fees a court may award to how the judgment compares with the amount stated in the notice, using ratios set out in the text. How that applies depends on the case, so talk to an attorney about it.
This summary does not cover deadlines for filing suit. TDI says you have the right to sue, and its disagreement page links to resources to find legal help. For any question about chapter 542A, talk to an attorney licensed in Texas.
Will a denied claim show up on your claims history?
It can. TDI explains that insurers report claims to the Comprehensive Loss Underwriting Exchange (CLUE) when you file one, including the date of loss, the loss type and the amount paid. A CLUE report covers the past seven years for a property, and you can get a free copy each year from LexisNexis.
TDI’s page on checking a property’s claim history says insurance companies look at a property’s past claims as a factor in deciding how much you pay. TDI says companies are not supposed to report questions you ask about your policy or deductible.
TDI adds that you can contact LexisNexis to dispute wrong information or add an explanation. If a denied roof claim appears on your report, ask your insurer how it was recorded.
How do you avoid making a denied claim worse?
Keep the claim honest and the paperwork complete. TDI says it is illegal for a contractor to waive your deductible or help you avoid paying it, including by inflating an estimate. TDI also warns against contracts with blank spaces and paying in full up front. Each of these can damage a claim that is already in dispute.
TDI’s page on whether a contractor can waive your deductible says the insurer can ask for proof that you paid your deductible before it pays the full claim. That proof might be a canceled check, a money order receipt, a credit card statement or a copy of a payment plan with your contractor.
Where does a roofer fit after a denial?
A roofer’s role is the roof itself: documenting what is there and writing a clear itemized estimate. TDI suggests sending a contractor’s estimate with your disagreement. A roofer cannot decide coverage, promise an outcome or give legal advice. Your insurer and, where needed, your attorney handle those.
For a Plano-area home, a useful estimate lists each part of the roof, the materials and the quantities. The team at Roofing Repair Plano can help you document roof damage for an insurance claim and explain the estimate. It cannot tell you what your insurer will pay, and nobody honest will.
For the wider picture of hail, insurance and safety, start with our guide to protecting a Plano home from hail and insurance problems.
Frequently asked questions
Can I reopen a roof insurance claim that was denied?
TDI says that if you disagree with the adjuster’s final estimate, tell the company why and send supporting documents, such as a contractor’s estimate. The company may have overlooked something and may make adjustments. If you still disagree, TDI lists appraisal, a complaint, mediation and court as options. Ask your insurer how it handles your request.
Does every Texas homeowners policy have an appraisal clause?
Not necessarily. TDI says your policy may include an appraisal process. Read your policy, or ask your insurer in writing whether it has an appraisal clause and what the deadline is to demand it. TDI says the umpire’s decision is binding on both you and the company, and you pay your own appraiser plus half the umpire’s expenses.
Does the insurer have to explain a denial in writing?
Yes. TDI says the insurance company must tell you in writing why it denied a claim. If you have not received a written reason, ask the company for one. Keep the letter with your policy, the adjuster’s estimate and your photos, because every next step starts from the reason the insurer gave.
Will a denied hail claim raise my premium?
TDI does not say a denied claim raises premiums. It says insurers look at a property’s past claims as one factor in pricing, and that CLUE reports can include claims you file. You can get a free CLUE report each year from LexisNexis and dispute wrong information. Ask your insurer how your claim was recorded.
Do I need a lawyer to dispute a denied roof claim?
Not for every step. TDI describes telling the company why you disagree, appraisal and complaints as options. Before suing, Texas Insurance Code chapter 542A sets written notice requirements for storm damage lawsuits, and the insurer may ask to inspect. Talk to an attorney about any lawsuit or anything under chapter 542A.
