A policyholder recently reached out after their claim was denied. The denial letter referenced “wear and tear” as the cause of loss—something almost universally excluded in homeowners insurance policies.
So, how did this claim get filed in the first place?
The homeowner had consulted their contractor, who reviewed the policy and mistakenly told them that wear and tear was a covered loss. Encouraged by this advice, the homeowner filed a claim. The result? A swift denial from the insurance company—and wasted time and energy that could have been directed toward a legitimate path forward.
The Problem: Contractors Are Not Authorized to Interpret Policies
This scenario is not uncommon, and it highlights an important boundary in the claims process.
Only licensed public insurance adjusters or attorneys can legally interpret an insurance policy or advise a policyholder about their coverage.
As our own FAQ at Pine Hills Property Claims explains:
“A contractor cannot represent the interests of the policyholder. This type of representation is often referred to as 1st party representation. Only an attorney or a public insurance adjuster can represent the interest of a policyholder in an insurance claim.”
While many contractors are well-meaning and experienced in construction, they are not licensed or qualified to interpret insurance policies or advise on claim validity. This includes identifying covered versus excluded losses, negotiating with insurance companies, or preparing claim documentation on your behalf.
What Is “Wear and Tear” and Why Is It Excluded?
“Wear and tear” refers to gradual deterioration—things like aging shingles, corroded pipes, or long-term settling. It is considered a maintenance issue, not a sudden, accidental event.
As stated by the Merlin Law Group:“Most property insurance policies exclude losses caused by wear and tear, rust, corrosion, or deterioration. These are considered maintenance issues, not sudden and accidental losses.”Source: Merlin Law Group Blog
That means if a claim is based solely on wear and tear, it will almost certainly be denied—regardless of what anyone thinks the policy says.
What Can Contractors Do—And Not Do?
Contractors can:
Offer an opinion about visible damage.
Create repair or replacement estimates.
Recommend that a claim be filed.
Be present during insurance inspections.
Answer questions about their scope of work.
Contractors cannot:
Interpret policy language.
Determine what is or isn’t covered.
Negotiate directly with insurers on behalf of the homeowner.
File a claim or advocate for your best interests.
The Role of a Public Insurance Adjuster (and When to Bring in an Attorney)
At Pine Hills Property Claims, we’re licensed to:
Review and interpret your policy.
Advise on your coverages.
Prepare and file your claim.
Negotiate directly with your insurance company.
Evaluate and document the full scope of your loss.
Advocate for your rights under state insurance laws.
Key Takeaway: Don’t Let Good Intentions Lead to Denied Claims
Most contractors genuinely want to help. But interpreting an insurance policy requires specific licensing and expertise. Filing a claim based on a contractor’s interpretation—even if well-intended—can lead to avoidable denials, delays, or worse, damage your chances of recovery for legitimate damage.
If you’re facing a denied claim—or don’t know where to begin—talk to a licensed public insurance adjuster first. At Pine Hills Property Claims, we’ll guide you through every step of the process and ensure you get the professional representation you deserve.
📞 Call us today at 651-409-2050
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