I am handling a commercial property claim where the ice damming caused the modified membrane damage in the area by the gutter. As a result of the damage, water penetrated into the building causing damage to the suspended ceiling. Insurer allowed for the interior repairs. However, the flat roof was insulated above the roof deck: insulation was installed directly under the membrane. As a result of the water penetration, the roof's insulation was also affected. Wet insulation looses its intended properties and thus was damaged as a result of the ice damming. Roof membrane was otherwise older and had some damages caused by the regular wear and tear. I have tried to extend the coverage to include the replacement of the wet insulation in settlement. Of course, that would mean that the membrane itself must be removed in order to access the wet membrane. Insurer denied the coverage for the roof due to the excluded wear and tear and doesn't address the damaged insulation, again arguing the exclusion for wear and tear. So far, there were two denial letters; however, both seem to be in part contradicting. Insurer denies the coverage for the roof due to the wear and tear exclusion, but then reaffirms that there was a water seepage that resulted from the ice damming. It boils down to the question: is damaged insulation covered due to the loss caused by ice damming and whether the roof repairs are covered as an operation necessary to access the damaged roof's insulation. 

Additional information: 

Wear and tear of the roof is unquestionable; however, the damage was caused by the water seepage near the gutter where ice damming occurred. The homeowner is not claiming the replacement of the roof membrane, but only damages to the roof's insulation that was damaged by the same seepage that damaged the interior.