How to File Insurance Complaint with Peru SBS

Peru's Superintendencia de Banca y Seguros (SBS) is the federal regulator that oversees all private insurance companies operating in the country. If a private health insurer — Rímac Seguros, Pacífico Seguros, La Positiva, Mapfre Peru, or any other SBS-regulated insurer — denied your claim, delayed your coverage, or engaged in unfair practices, the SBS has authority to investigate and order remediation. This guide explains the SBS complaint process from start to finish.

What Is the SBS?

The Superintendencia de Banca, Seguros y AFP (SBS) regulates Peru's financial system, including banks, insurance companies, and pension funds. Its insurance division supervises all private health and life insurers to ensure they comply with Peru's insurance law (Ley 29946 — Ley del Contrato de Seguro) and related regulations.

The SBS can:

• Investigate complaints against private health insurers
• Order mediation between you and your insurer
• Impose administrative sanctions on non-compliant insurers
• Refer cases to Peru's financial courts for further action
• Publish findings that affect an insurer's regulatory standing

The SBS is accessible at sbs.gob.pe and at its Lima headquarters (Avenida Javier Prado Oeste 4016, San Isidro, Lima).

When to File With the SBS

File an SBS complaint when:

• Your private health insurer (Rímac, Pacífico, La Positiva, Mapfre, etc.) denied a claim you believe is covered by your policy
• Your insurer is not responding to your internal reclamo within a reasonable period
• Your insurer is applying policy exclusions or waiting periods incorrectly
• You were charged more than your policy allows
• Your insurer misrepresented coverage terms when you purchased the policy
• Your insurer is delaying reimbursement without adequate justification

Note: The SBS handles complaints against private insurers only. For EsSalud disputes, use the Defensoría de la Salud y Transparencia and SUSALUD. For SIS disputes, use MINSA channels.

What You Need Before Filing

Gather the following before starting your SBS complaint:

1. DNI (Documento Nacional de Identidad)
2. Your insurance policy number (póliza) — on your policy document or insurance card
3. The written denial from your insurer — request this if you have not received it
4. Your medical documentation — physician's prescription, diagnosis, and clinical records supporting the denied claim
5. Your internal reclamo filed with the insurer and the insurer's response (if any)
6. The relevant policy clause — the provision in your contract that you believe covers the denied service (benefit schedule / tabla de coberturas)
7. Bills and receipts — if you paid out of pocket for denied care, include the receipts for reimbursement purposes

How to File Your SBS Complaint

Step 1: Go to sbs.gob.pe

Navigate to the SBS website. Look for the "Atención al Usuario" or "Reclamos" section. The SBS operates an online complaint platform (Sistema de Atención al Usuario de Seguros).

Step 2: Access the Complaint Platform

The SBS complaint system may require registration with your DNI and contact details. Some complaint categories are accessible without prior registration. Follow the prompts to access the complaint form.

Step 3: Select "Seguros" as the Sector

The SBS regulates banking, insurance, and pensions. Select "Seguros" to access the insurance complaint section.

Step 4: Complete the Complaint Form

The form will ask for:

• Your personal information (name, DNI, contact)
• Your insurer name (e.g., "Rímac Seguros y Reaseguros")
• Your policy number
• Type of insurance (Seguro de Salud / EPS Privada)
• Description of the dispute: the denied service, denial date, denial reason, and why you believe the denial is incorrect
• What you are requesting (authorization, reimbursement, correction of policy terms)

Be specific and factual. Write clearly: "My insurer [Rímac Seguros] denied coverage for [specific service] on [date], stating [reason]. My policy benefit schedule (tabla de coberturas) lists this service as covered under [specific benefit category]. I request that the SBS investigate this denial and order my insurer to [authorize coverage / reimburse Soles amount]."

Step 5: Upload Supporting Documents

Attach digital copies of:

• Insurance denial letter
• Your policy benefit schedule (tabla de coberturas) — particularly the relevant section
• Physician's prescription and clinical records
• Your internal reclamo to the insurer and the insurer's response
• Receipts for out-of-pocket costs (if seeking reimbursement)

Step 6: Submit and Record Your Reference Number

After submission, you receive an expediente number (case reference). Record this for tracking and follow-up.

What Happens After You File

Insurer notification: The SBS formally notifies your insurer of the complaint, requiring a written response within a set period.

SBS review: The SBS insurance division reviews the complaint, the insurer's response, and supporting documentation. They may request additional information from you or the insurer.

Mediation: For many insurance disputes, the SBS offers a conciliation process where a neutral SBS mediator facilitates a settlement between you and the insurer. Mediation is particularly effective for:

• Reimbursement amount disputes
• Policy interpretation disagreements
• Partial denial cases where the coverage amount is disputed

Resolution: If mediation is not applicable or not successful, the SBS can:

1. Issue a regulatory finding that the insurer's denial violated insurance law or policy terms — which pressures the insurer to settle
2. Order the insurer to provide coverage or reimburse you
3. Impose administrative sanctions on the insurer
4. Refer the case to the Tribunal Administrativo for further administrative adjudication

Timeline: SBS complaint processing typically takes 30-90 days depending on complexity. Request urgent processing explicitly if your health situation is time-sensitive.

In-Person Filing at SBS Lima

For Lima residents, the SBS accepts in-person complaint filings at its San Isidro offices. Bring printed copies of all documents. In-person filing may be faster for urgent cases and allows direct interaction with SBS staff who can guide your complaint.

SBS Mediation: What to Expect

SBS-mediated conciliation is a structured process where:

1. Both you and your insurer submit written positions
2. A SBS conciliator conducts one or more sessions (often by phone or video)
3. The conciliator guides both parties toward a settlement
4. If settlement is reached, a formal agreement is signed and the insurer must comply

Conciliation is free of charge and is often faster than a full regulatory investigation. Many insurance disputes are resolved at this stage.

INDECOPI as a Parallel Route

Alongside your SBS complaint, consider filing with INDECOPI (Instituto Nacional de Defensa de la Competencia y de la Protección de la Propiedad Intelectual) for consumer protection violations. INDECOPI can sanction insurers for:

• Failing to respond to reclamos within regulatory timeframes
• Misrepresenting coverage at point of sale
• Denying legitimate claims to force out-of-pocket payment

INDECOPI has a streamlined online complaint process at indecopi.gob.pe.

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• How to Write an Insurance Appeal Letter
• What Is Medical Necessity?
• Internal vs External Insurance Appeal