Openly

Gina Reyes

Claims Transformation Authority

What is Actually Making Claims Harder

High frequency hail markets present a different set of challenges to traditional catastrophe scenarios. It comes from the conditions surrounding each claim, not just the storm itself. There’s significantly more third-party involvement than in the past, including contractors, public adjusters, and attorneys, who are actively shaping customer expectations early in the process. Messaging around maximizing payouts or avoiding deductibles can shape customer expectations before the claim is even filed. 

At the same time, repair costs have increased substantially. A roof that once cost a few thousand dollars can now cost tens of thousands, which has implications for coverage, pricing, and claim outcomes. Combined with more frequent weather events, this has driven higher claim volume and increased reliance on less experienced inspectors and adjusters. In many cases, roof inspectors today often lack the hands-on experience, which can lead to more variability in how damage is assessed.

There’s also greater use of generalized or unverified data. While carriers rely on forensic weather reports that provide detailed, property-specific information, third parties often use free or less reliable data sources that reflect broader conditions rather than what actually occurred at a specific address. That information is then presented to homeowners as support for a claim, even when it may not align with the conditions at the property itself. Taken together, these dynamics introduce more complexity, extend timelines, and make getting all parties on the same page more difficult.

Cutting through that complexity to determine accurate causation requires a more complete, property-level view. Rather than anchoring on a single reported event, claims teams need to look at the full sequence of weather activity affecting that location over time. High-quality forensic weather data helps establish what actually occurred at the property, including timing and severity, instead of relying on broader regional reports.

That needs to be combined with prior claims data to understand whether damage has already been reported or paid. Permit and repair records can also help clarify when major work was done. Knowing when a roof was last replaced or repaired makes it easier to determine whether the damage being presented lines up with a recent event or something older.

No single source gives a complete picture. It’s pulling those pieces together that allows for a more accurate timeline and a clearer view of what’s new versus what may have already been addressed.

Skills Communication and Claims Strategy Ahead

Navigating that complexity demand a different kind of adjuster. The role today involves bringing together different pieces of information rather than relying on a single inspection. Adjusters are working with weather data, photos, and third-party reports, and none of it tells the full story on its own. They are expected to connect those inputs and make sense of what actually happened at the property.

At the same time, the way adjusters build that understanding has changed. In the past, a lot of it came from physically being on roofs, seeing the damage firsthand, understanding construction materials, and building that foundation through hands-on experience. Adjusters went through training, got out in the field, and learned what different types of damage actually looked like.

Now, more of the work is done remotely, which makes validation essential. That includes confirming when and where photos were taken, making sure materials align with the property, and catching inconsistencies. Even simple checks, like verifying photo location data, can make a difference.

Experience still shows up in how confidently adjusters interpret what they’re seeing. For newer adjusters, that means leaning on peers, talking through claims, and building that pattern recognition over time.

How the validated information is communicated to the policyholder shapes the entire claims experience. Clear, consistent communication plays a central role in how the claim unfolds. Many policyholders come in with prior experience or input from contractors or others, so expectations are often already set before the first conversation. Taking the time upfront to walk through the process and answer questions helps set realistic expectations and reduces the chance of disputes later. Agents can play an important role here, helping set expectations early and reinforcing what the process will involve before a claim is even filed.

Following through on what’s been communicated matters just as much. If you tell a customer you’ll call in two days and you don’t, you’re losing credibility and trust, and that’s difficult to recover. There’s already a perception challenge around the insurance company, so consistency in communication becomes part of how you build confidence throughout the claim.

There’s also more hesitation now around filing claims, often tied to concerns about rising rates, higher deductibles, or changing coverage. Customers may wait, get a large estimate from a contractor, and then enter the process later than they should have. That delay often makes the situation more complicated, and the insurer has less opportunity to guide early decisions or help mitigate further damage.

A more collaborative approach helps. Giving customers options in how they want to communicate, making sure they understand their choices, and being both informative and empathetic goes a long way in keeping the claim on track.

Beyond individual claims, the broader strategic response to sustained frequency is also evolving. Carriers are already adjusting across several areas in response to sustained claim frequency. Policy structures are evolving, including higher deductibles and more defined roofing coverage, because repeated losses make the old models unsustainable.

There’s also more emphasis on inspections earlier in the process. Establishing a clear baseline condition at underwriting helps reduce uncertainty when future claims come in.

From a portfolio standpoint, managing geographic concentration is becoming more important. Spreading exposure across regions helps reduce the impact of frequent events in any one area.

Mitigation is another area getting more attention. Fortified roofing and stronger building practices can help properties better withstand hail and wind, which ultimately helps reduce claim severity.