Roof Claim Denied as Wear and Tear: Reading the Letter

20 August 2026 · 9 min read

Your customer forwards you the letter. Two pages, sometimes three. Somewhere in the middle sits a sentence about granule loss consistent with age and normal wear, and after that the file is closed.

You have read this letter before. Different carrier, different state, nearly the same paragraphs. That is not laziness and it is not a conspiracy. Much of that structure exists to satisfy a state claim-handling rule.

Why the letter reads like a form

Claim handling is regulated state by state. Where the rules require a written, reasoned denial, the letters written to satisfy them start to look alike. Two published examples you can pull up yourself.

California's fair claims settlement practices regulations require an insurer that rejects or denies a first party claim, in whole or in part, to give the claimant a statement listing all bases for that decision. Where the denial rests on a statute, applicable law, or a policy provision, condition, or exclusion, the written denial has to reference it and explain how it applies to the claim. That is 10 CCR 2695.7(b)(1), indexed with the rest of the regulations on the California Department of Insurance site. Not just name the exclusion. Explain the application.

Florida's property claim statute reaches the same place from another angle. When a carrier pays, denies, or partially denies, it has to give the policyholder a reasonable written explanation of the basis in the policy, in relation to the facts or applicable law. If it pays less than its own detailed estimate, it has to explain the difference in writing. The same statute requires the carrier to send the policyholder a copy of a detailed estimate generated by its adjuster, within the window the statute sets, and requires claim communications to carry the name and license number of the adjuster (§ 627.70131, Fla. Stat. (2024)).

Your state's rules are their own. Look them up before you lean on any of this. But where a rule of that kind applies, the denial is supposed to be written, tied to policy language, and — this is the part contractors skip past — tied to facts. Naming an exclusion is not the end of it. The letter is supposed to say why that exclusion reaches this roof.

The blocks to mark on the letter

Print it. Hand your customer a pen. There are usually seven blocks, and only one of them is load-bearing.

1. The dates. Date of loss claimed, date reported, date inspected. Gaps get used later.
2. Who looked, and under what license. Name, license number, staff or independent. Florida, above, requires that on claim communications. Where a state does not, the homeowner can still ask.
3. The observation. What the inspector says they saw. Granule loss, craze cracking, curling, nail pops, blistering. This is a factual assertion, and factual assertions can be wrong.
4. The named exclusion. The quoted policy words. Wear and tear, deterioration, marring, latent defect, faulty workmanship, sometimes a cosmetic damage endorsement.
5. The bridge. One sentence, usually short, connecting block 3 to block 4: the observed conditions are consistent with long-term deterioration and therefore fall within the exclusion cited above. That sentence is the entire letter. Everything else is scaffolding around it.
6. The outside report. Engineer's letter, lab shingle test, third-party weather data. If the letter leans on one, the homeowner can ask for a copy in writing.
7. Rights and clocks. Reconsideration, appraisal, the state insurance department, and any deadline the letter gives for filing suit. That last one is a date. Write it on the top of the page.

"This is wear and tear" is two claims, not one

This is the part that changes how you work the file.

When an adjuster writes that a roof is worn out, two very different statements have been stacked into one sentence:

• A physical observation. Granule cover is depleted, the asphalt underneath is oxidized and hard, the mat is intact, craze cracking runs across the field, no soft metal on the property is dented.
• A coverage conclusion. Therefore this loss sits inside the exclusion.

The first is testable. You can climb up and test it. The second is not something a photograph answers, and it is not your call to make. Keep those two apart in your head and in your paperwork, because the letter runs them together.

Notice also how much of what gets treated as physics is really convention. The test square — a chalked ten-by-ten area with impacts counted inside it — is adjusting practice, not a code requirement. You will not find it in the residential code chapter that governs roof coverings, and no statute sets it. The hit count used as the line between repair and replacement is convention in the same way. Conventions get applied loosely, applied to the wrong slope, or applied to a roof where the count was never the real question.

Cosmetic works the same way. Texas adopted an optional homeowners endorsement, HO-145, that excludes cosmetic loss or damage to roof coverings caused by hail, and the endorsement defines cosmetic in functional terms: damage that changes how the roof covering looks without letting water through it and without keeping it from performing its intended function. That endorsement may be attached only to a policy eligible for and receiving the premium credit for an impact-resistant roof covering (TDI Bulletin B-0030-98). Two things follow. The test written into that endorsement is a function test, and function is something a camera can document. And the endorsement has to actually be on the policy. The word cosmetic shows up in letters written against policies that never carried one.

Three answers, and what each one costs you in evidence

One: the reinspection, with you on the roof. The homeowner requests it. You attend. It is the cheapest of the three and the easiest to let slide. What it costs you: chalked test squares photographed in place, soft-metal collateral documented before the next storm muddies it, and date-of-loss corroboration pulled from the NOAA Storm Events Database or the Storm Prediction Center archive. Bring hail size and date for that grid square in writing. Do not bring an argument about the policy.

Two: the written supplement package. This is the paper answer, and it is aimed at the partial denial, where the slope was approved but individual line items were struck as pre-existing. What it costs you: measurements, photos indexed to slope and elevation, manufacturer installation instructions for the specific product, and the code edition your jurisdiction actually adopted. Drip edge at eaves and rakes, and ice barrier where the climate criteria call for it, are common casualties in this block; a code requirement applies to the roof being installed regardless of what caused the tear-off. Write "this state adopted the 2021 IRC, and R905.2.8.5 requires drip edge at eaves and rakes" rather than "the IRC says" — editions and state amendments differ, and getting that detail wrong costs you the reader. We went through the line-item list and the rejection that typically comes back for each one in the supplement item list, and drip edge specifically in the drip edge write-up.

Three: the homeowner's lane. Appraisal, a complaint to the state insurance department, or counsel. Whether a particular dispute belongs in appraisal at all is a legal question that turns on the policy wording and the state, and it is not yours to answer. Hand the homeowner your documentation and let them and whoever advises them pick the door.

The line you do not cross

Here is the uncomfortable part.

The moment you argue that the exclusion does not apply, you are arguing coverage. In many states that is public adjusting, and public adjusting is licensed. Texas is blunt about it: the Department of Insurance tells roofers that if you provide, or may provide, contracting services on the property, you are prohibited from acting as a public adjuster or advertising to adjust claims, citing Insurance Code 4102.163, and it warns against telling an insurer that you represent the policyholder or can speak for them on coverage (TDI, Roofing and insurance: know the law). Other states have their own versions. Check yours before you write a word.

The practical rule is simple and it costs you nothing: you write what is true about the roof. The homeowner submits it and decides what it means.

In your report, that is the difference between two sentences. The mat is fractured at six of the ten marked impacts on the west slope, photographed and indexed below is a fact about a roof. This damage is covered and the exclusion does not apply is a coverage opinion. The first one helps your customer. The second one puts you on the wrong side of a licensing rule, and in some states it ends the conversation about your work and starts one about your license.

The frames that separate the two claims

Since the physical observation is the only half you own, shoot it properly.

• Soft-metal collateral, close and wide. Gutter apron, downspouts, roof vents, HVAC condenser fins, fence caps, the mailbox. Age does not dent aluminum. This is the strongest physical answer to a deterioration theory, and it decays fast, so shoot it early.
• The orientation set. One full-slope frame per elevation, labeled with the compass direction. Sun-driven wear generally tracks the sun: south and west slopes take the most UV and thermal cycling. Storm damage tracks the storm. If the north slope is the worst and the south slope is clean, the aging hypothesis has something to explain.
• Exposed asphalt, close-up. Freshly exposed asphalt under a displaced granule field does not look like asphalt that has been open to UV for years. Shoot it dry, in even light, with something in frame for scale.
• The test square in context. Chalk the square, then take one frame tight enough to count and one wide enough to show which slope it is on. A count with no location is not evidence.
• The tactile frame. Thumb on the bruise, bruise in frame. It does not prove softness on its own, but it puts the observation in the record where an inspector has to address it.
• The negative frame. An undamaged reference area on the same slope, same age, same exposure. Uniform deterioration is a hard argument to make against a slope that is half pristine.
• The function frame. Underside of the deck, daylight through, moisture staining, fastener corrosion. Where a cosmetic endorsement is in play, function is the written test, so document function.

Keep the original files. Do not re-export, do not run them through a resizer that strips EXIF. The embedded timestamp is part of the evidence and it is the part you cannot recreate later.

None of this decides the claim. It makes sure the decision gets made against the roof that is actually up there, instead of against a sentence in a template.

This article is general information about claim documentation and building code practice. It is not legal advice, and it is not an interpretation of any particular insurance policy. Code adoptions, licensing rules, and claim-handling requirements vary by state and by edition, and they change. Consult a licensed attorney or a licensed public adjuster in your state about a specific claim.