How does a roof insurance claim adjuster decide claims?

The chain of decision

1. Field adjuster. Inspects, photographs, counts hail hits, measures and drafts the estimate. On many storm claims this is an independent adjuster hired for the event.
2. Desk adjuster or examiner. Reviews the file against the policy: is the peril covered, does an exclusion apply, which deductible, replacement cost or actual cash value. They approve the estimate or send questions back.
3. Authority limits. Adjusters can approve payments only up to a set amount, so bigger claims move up a level, which adds time.
4. Specialists. An engineer may be ordered when cause is disputed, and a coverage specialist on unusual policy questions.

What the decision letter tells you

You will receive one of four things: an estimate with payment, a partial denial that excludes some items or slopes, a full denial citing policy language, or a reservation of rights letter saying the insurer is still investigating while keeping the option to deny. Note which policy section is cited, because that is what any response has to address.

How to influence it fairly

The field adjuster's documentation drives everything after it, so the inspection is where most roof claims are won or lost. Be present, have your roofer there and make sure every damaged slope is photographed. After the decision, send new evidence in writing to the desk adjuster as well as the field adjuster, and ask for a reinspection if needed. If the answer is a denial, see what to do when a roof claim is denied.