Roof Wear & Tear / Maintenance Denial
Dear {{named_insured}},
1. Context We have completed our investigation of your claim for roof damage at {{loss_location_address}}, reported under claim number {{claim_number}} for the date of loss {{date_of_loss}}. Our investigation included a physical inspection of your roof on {{inspection_date}} by {{adjuster_name}}.
2. The Decision After a thorough review of the facts and your policy, we have determined that there is no coverage for the damage to your roof. Therefore, we must respectfully deny your claim in its entirety.
3. The Evidence Our inspection revealed that the leaks you reported are the result of long-term wear and tear, lack of maintenance, and the natural deterioration of the roofing materials. Specifically, we observed that the shingles have reached the end of their useful life, are brittle, and have significant granule loss. There was no evidence of sudden or accidental physical loss, such as hail or wind damage, that would be covered under your policy.
4. The Policy Basis Your policy, number {{policy_number}}, contains the following relevant provisions:
> Section I - Exclusions > We do not insure for loss caused directly or indirectly by any of the following... > 1. Wear and tear, marring, deterioration; > 2. Inherent vice, latent defect, mechanical breakdown; > 3. Smog, rust or other corrosion, mold, wet or dry rot...
Furthermore, the policy requires that you maintain the property in good repair. Because the damage was caused by ongoing deterioration and lack of maintenance rather than a covered peril, these exclusions apply to your claim.
5. The Path Forward If you have additional information or documentation that you believe we should consider, such as recent maintenance records or a different assessment from a qualified professional, please submit it to us at your earliest convenience. You also have the right to have this decision reviewed by our internal appeals department or to contact your state's Department of Insurance if you remain dissatisfied with this outcome.