Insurance claim denied or ignored in Peru: what deadlines does the insurer have and what can you do?

This page applies to any insurance

Ley 29946, the Insurance Contract Law, “se aplica a todas las clases de seguro” (applies to all classes of insurance): home, life, accident, vehicle, liability. For mandatory insurance and insurance governed by a special law, it applies only to fill gaps. The SBS (the banking and insurance regulator) adds the Claims Management and Payment Regulation (Resolución SBS 3202-2013), which binds every insurance company:

“Las disposiciones del presente Reglamento son aplicables a las empresas de seguros a que se refiere el literal D del artículo 16° de la Ley General, en adelante las empresas, así como a los ajustadores de siniestros, en lo que corresponda.”

(The regulation applies to insurance companies and, where relevant, to loss adjusters.)

If your problem is with car insurance or SOAT, we have a dedicated guide: vehicle insurance vs. SOAT. Here we cover the rules common to all insurance. In Peru a claim is called a siniestro, and a complaint a reclamo.

First: reporting the loss

The law does not set the period itself. It hands that to the SBS:

“El contratante, el asegurado, el beneficiario, en su caso, o cualquier tercero, comunicarán al asegurador el acaecimiento del siniestro en los plazos que para dicho efecto establezca la Superintendencia acorde con la naturaleza o tipo de seguro.”

(The policyholder, insured, beneficiary or any third party must report the loss within the periods the SBS sets for each type of insurance.)

The SBS set them in article 3 of the regulation:

If you reported late

Few people know this. The same article 3 says:

“El incumplimiento de los plazos antes señalados por el asegurado o el beneficiario, no constituyen causal del rechazo del siniestro, pero las empresas podrán reducir la indemnización hasta la concurrencia del perjuicio ocasionado cuando se haya afectado la posibilidad de verificar o determinar las circunstancias del siniestro […]”

(Missing those deadlines is not a ground to deny the claim, but the insurer may reduce the payout up to the harm caused, if the delay affected its ability to verify the circumstances.)

Late notice alone is not a reason to deny. At most, the insurer can pay you less, and only if your delay kept it from checking what happened. If you prove you were not at fault, or that there was an unforeseeable event, force majeure or a practical impossibility, there is no reduction. The article makes exceptions in the paragraphs that follow, which we do not cover here.

Who has to prove what

Article 77 of Ley 29946 splits the burden of proof:

“Corresponde al asegurado demostrar la ocurrencia del siniestro, así como la cuantía de la pérdida si fuera el caso, y al asegurador la carga de demostrar las causas que lo liberan de su prestación indemnizatoria.”

(The insured must prove the loss happened and, where relevant, how much was lost; the insurer must prove the causes that free it from paying.)

In practice:

• You prove the loss happened and how much you lost: police report, photos, invoices, medical reports, whatever your policy asks for.
• The insurer proves the exclusion, the breach or whatever cause it says frees it from paying. You do not have to prove the exclusion does not apply.

Two more rules help you. Unclear policy terms “se interpretan, en caso de duda, a favor del asegurado” (are read, when in doubt, in favour of the insured) under article II of the law. And if you are a consumer, the Consumer Protection Code also applies, and in a conflict the rule more favourable to you wins (article I).

One rule works against you: article 73 says you lose the right to be paid if you act fraudulently, exaggerate the damage or use false means to prove it.

How long the insurer has to answer

When no loss adjuster is involved, article 11 of the regulation says:

“Dentro de los treinta (30) días siguientes a la fecha de haber recibido la documentación e información completa exigida en la póliza para el proceso de liquidación del siniestro, la empresa deberá pronunciarse sobre el consentimiento o rechazo del siniestro.”

(Within 30 days of receiving the complete documents and information the policy requires, the insurer must accept or deny the claim.)

If it needs clarification, it must ask within the first 20 days of that period, and the clock is paused until you provide what is missing. That is why you should keep a dated receipt for every delivery.

When a loss adjuster is involved, the deadlines change and depend on the adjustment agreement (convenio de ajuste). We explain them in the vehicle insurance vs. SOAT guide, but they apply to any insurance.

If the insurer does not answer: the claim is deemed accepted

Silence is not a denial. It is an acceptance. Article 74 of Ley 29946 says:

“En los casos en que, objetivamente, no exista convenio de ajuste, sea porque no se ha requerido la participación del ajustador o este aún no ha concluido su informe, se entenderá como consentido el siniestro cuando la aseguradora no se haya pronunciado sobre el monto reclamado en un plazo que no exceda de los treinta (30) días contados desde la fecha de haberse completado toda la documentación exigida en la póliza para el pago del siniestro, salvo lo señalado en el párrafo siguiente.”

(Where there is no adjustment agreement, the claim is deemed accepted if the insurer has not ruled on the amount claimed within 30 days of the policy’s required documents being complete, subject to the next paragraph.)

The exception is an extension. The insurer can ask you to extend the deadline to investigate; if you refuse, it can ask the SBS, and it must tell you about that request within 3 days of starting the procedure (article 12 of the regulation). If none of that happened, the claim is accepted.

Once accepted, a second clock starts: payment.

“Una vez consentido el siniestro, la empresa cuenta con un plazo de treinta (30) días para proceder a efectuar el pago que corresponda; caso contrario, la empresa deberá pagar al asegurado o al beneficiario un interés moratorio anual equivalente a uno punto cinco (1.5) veces la tasa promedio para las operaciones activas en el Perú”

(Once the claim is accepted, the insurer has 30 days to pay; otherwise it owes annual late-payment interest of 1.5 times the average lending rate in Peru.)

If the insurer denies: what the letter must say

A denial cannot be one line. Article 15 of the regulation requires grounds:

“La empresa debe informar detalladamente, mediante comunicación cursada al asegurado o al beneficiario, según corresponda, a través de los mecanismos y en las direcciones pactadas en la póliza, los motivos que sustentan el rechazo del siniestro, adjuntando copia de los documentos tomados en cuenta para fundamentar su decisión, debidamente suscrita por el responsable del área encargada de evaluar los siniestros.”

(The insurer must explain in detail, through the channels agreed in the policy, the reasons for the denial, attaching copies of the documents it relied on, signed by the head of the claims area.)

That letter must reach you within the same period the insurer has to decide. Article 17 also requires the denial letter to include this text:

“En caso de disconformidad con los fundamentos del rechazo del siniestro, usted podrá acudir a las vías de solución de controversias, como son la Defensoría del Asegurado (www.defaseg.com.pe), el Instituto Nacional de Defensa de la Competencia y de la Protección de la Propiedad Intelectual – INDECOPI (www.indecopi.gob.pe), o el Poder Judicial o instancia arbitral, según se haya pactado. Para solicitar orientación, podrá comunicarse con la Plataforma de Atención al Usuario de la Superintendencia de Banca, Seguros y AFP al teléfono gratuito 0-800-10840.”

(If you disagree with the grounds, you can go to the Defensoría del Asegurado, Indecopi, or the courts or arbitration as agreed; for guidance, call the SBS free line 0-800-10840.)

If the letter lacks reasons, documents or this text, write it down: it is one more argument in your complaint.

How to complain, in order

1. Complaint to the insurer. Article 16 of the regulation lets you complain to the company itself if you disagree with the grounds for denial. The SBS Complaints Management Regulation (Resolución SBS 04036-2022) also applies to insurance companies and says “los reclamos deben ser resueltos por las empresas en un plazo no mayor a quince (15) días hábiles” (complaints must be resolved within 15 business days). If the answer goes against you, it must give reasons, make the supporting documents available and tell you which bodies you can turn to.
2. Defensoría del Asegurado. One of the routes the denial letter must name (defaseg.com.pe).
3. Indecopi. If you are a consumer, you can go to Indecopi. If the policy covers health risks, the body the complaints regulation names is SUSALUD.
4. Arbitration or the courts, depending on what was agreed.

On any of these routes you can submit your own expert reports or evidence. If your complaint is upheld, you can ask to be reimbursed for those costs (article 16 of the regulation).

The SBS gives guidance at 0-800-10840. We did not find anything in these rules saying the SBS decides your individual case.

Your deadline to sue

“Las acciones fundadas en el contrato de seguro prescriben en el plazo de diez años desde que ocurrió el siniestro.”

(Claims based on the insurance contract expire ten years after the loss occurred.)

It is a long period, but it runs from the loss, not from the denial.

What this page does not cover

We do not cover SOAT or car insurance in detail (they have their own guide), the special rules for health insurance, or the full procedure when a loss adjuster is involved. We did not review Indecopi or Defensoría del Asegurado decisions, or the Defensoría del Asegurado’s own rules. We do not say whether the regulation’s day counts are business or calendar days, because the text does not specify.

Check your case

The ten-year period for actions under the insurance contract appears, next to other kinds of debt, in When does my debt prescribe?.