Insurance company denies homeowner’s claim after roof caves in; says it’s a maintenance issue

CHICAGO (CBS) — The entire upstairs of a Northwest Indiana home is off-limits because of a rotten roof. The family says they’re in limbo, waiting on insurance to help.

Morning Insider Lauren Victory explains why they might not get the answer they are looking for.

“Those are all buckets full of water, how black they are,” said Martha Feliciano giving a tour of what was her bedroom to roofing expert Joshua Grah. “I mean, the mold right there is ridiculous.”

 The upstairs of her Portage home was musty.

“It’s horrible, the smell is horrible,” Feliciano said. She’s already moved her bed and son’s crib out of the bedroom.

“We’ve been literally sleeping on the floor,” the mother of six said.

She noticed leaking in March 2021 and filed a claim with State Farm. After going back and forth with insurance for more than six months, she got a letter with all sorts of legal language that, simply put, informed her that State Farm denied her claim, saying the problems inside the house are from rot and deterioration.

“I just gave up. I didn’t want to fight with them,” said Feliciano.

Then she came home to a ceiling caved in last month.

“I walked in and I just seen everything splattered all over the floor and I’m like <gasps> and I closed the door immediately,” she said.

The damage was even worse than before with debris all over the floor and insulation hanging from the ceiling. Feliciano may be stuck paying for it out-of-pocket.

State Farm couldn’t talk specifics in her case, but referred CBS 2 to Janet Ruiz from the Insurance Information Institute for general information about claims.  

Ruiz explains that roof replacement is usually only covered by insurers for an accidental loss like a wind storm or fire, not for rot and deterioration. Insurance is not a maintenance policy, she said.

“[If] it’s just a matter of age and wear and tear that have occurred over a long period of time that wouldn’t be a covered loss,” said Ruiz.

So, divine intervention might be needed for Grah’s bill and more.

“It’s expensive,” he said, not wanting to give us a specific number. Grah works for Restoration Builders of NWI.

Feliciano is praying for help and for sunny days ahead because the tarps on her roof right now can only block out so much rain.

She recently filed a second claim with State Farm and is patiently waiting to see if insurance will cover her this time around.