SOAT and the hospital bill after a traffic accident in Peru: what SOAT pays and what your own insurance pays

Who pays the clinic

After a traffic accident in Peru, the clinic or hospital bill is not paid first by your own health insurance. It goes to the SOAT (Seguro Obligatorio de Accidentes de Tránsito, the compulsory motor insurance) of the vehicle involved. This page deals only with that bill: who pays it, up to how much, and what happens when the cover runs out. What SOAT covers in general is in SOAT: mandatory car insurance in Peru. If the vehicle had a CAT or fled, see SOAT, CAT or the Compensation Fund.

The rule is in the SOAT regulation (the consolidated text approved by D.S. 024-2002-MTC). Its article 33, as rewritten by D.S. 012-2017-MTC, says:

“Los centros de salud públicos o privados, atenderán obligatoriamente a las víctimas de accidentes de tránsito debiendo, de ser el caso, cargar los gastos correspondientes a la póliza del Seguro Obligatorio de Accidentes de Tránsito, cuya contratación será acreditada con el Certificado SOAT físico.”

(Public and private health facilities must treat traffic accident victims and, where applicable, bill the expenses to the SOAT policy, shown by the paper SOAT certificate.)

If the SOAT is electronic, the same article says the facility checks it in the Ministry of Transport (MTC) database “sin perjuicio a la atención inmediata y obligatoria” (without affecting immediate, mandatory care). Not finding the certificate is no reason to refuse you treatment.

Article 33 also requires the owner, the driver, the transport company or the police to report the accident to the insurer, “la que deberá actuar de inmediato haciéndose cargo de los gastos médicos o gastos de sepelio de la víctima” (which must act at once and take charge of the victim’s medical or funeral expenses).

The insurer pays the clinic

Article 35 provides for the insurer to pay the facility that treated you directly:

“El pago de los gastos médicos también podrá realizarse, vía reembolso, directamente al centro o centros de salud privados que acrediten haber atendido a la víctima, en base a los convenios celebrados entre dichas entidades y las compañías de seguros, si los hubiere.”

(Medical expenses may also be paid, by reimbursement, directly to the private facilities that show they treated the victim, under any agreements they have with the insurers.)

Without an agreement, the clinic bills the insurer with its receipts, backed by your medical record. With public hospitals, reimbursement follows the tariff the health sector approves.

The insurer can dispute the clinic’s bill. That is between them: the same article says objections do not release the facility “de la obligación de brindar la atención médica que las víctimas requieran dentro del margen de las coberturas” (from its duty to give victims the care they need within the coverage).

How much SOAT pays

Article 29 sets the minimum cover per person. For the hospital bill, the line that matters is medical expenses:

“Gastos médicos c/u hasta : Cinco (5) UIT”

(Medical expenses, each person, up to five UIT.)

At the 2026 UIT, 5 UIT is S/ 27,500. The same article says these expenses include “la atención prehospitalaria, los gastos de atención médica, hospitalaria, quirúrgica y farmacéutica y otros gastos que sean necesarios para la rehabilitación de las víctimas” (pre-hospital care, medical, hospital, surgical and pharmacy costs, and other costs needed for the victims’ rehabilitation). Transport counts as a medical expense in only two cases: a transfer to a facility with greater capacity, or a transfer from the accident site to another city because of the nature or severity of the injuries.

The cap is per person. If three people were hurt, each has their own 5 UIT. Article 29 also allows a SOAT with higher cover to be bought, but that is the minimum.

When the 5 UIT run out

This is the part few people know. Article 36 sets the order of payment:

“Las indemnizaciones y prestaciones previstas por el Seguro Obligatorio de Accidentes de Tránsito se pagarán con preferencia a cualquiera otra que favorezca a la víctima o a sus beneficiarios en virtud de seguros particulares y/o coberturas propias del sistema de seguridad social, incluyendo la que provenga de la legislación sobre accidentes del trabajo, las que se pagarán en la parte no cubierta por el seguro que se establece en este Reglamento.”

(SOAT benefits are paid ahead of any other benefit the victim has under private insurance or social security cover, including work-accident cover; those pay the part not covered by SOAT.)

In practice:

• SOAT goes first. Even if you have an EPS or private health insurance, the clinic must bill SOAT first.
• Your other insurance covers the rest. Private insurance and social security cover pay “la parte no cubierta” (the part not covered) by SOAT.

The article does not name EsSalud, the EPS or the SIS, and does not explain how one insurer hands over to the other. We did not review what your policy or scheme says about that step.

If the vehicle was never identified and fled, the Compensation Fund pays instead. Its regulation, as amended by D.S. 017-2022-MTC, says: “La cobertura médica se otorga hasta la emisión del alta o hasta que se agote las cinco (5) UIT.” (Medical cover lasts until discharge or until the five UIT are used up.)

Can the clinic bill you?

The norms we read do not say so in those words. What they do say:

• Within the cover, the clinic treats you and bills SOAT (article 33), and collects from the insurer (article 35).
• Above the cover, your private insurance or social security pays, if you have them (article 36).

If you have no other insurance, the regulation does not say who pays what exceeds 5 UIT. In practice, the clinic is likely to bill you. Who is liable to you for the accident’s damage is covered in what to do after a car crash.

If the clinic will not let you leave until you pay, see patient detention for non-payment.

Where to complain

Two different problems, two routes:

On the insurer, the SBS says it cannot order payment itself: that power “corresponde de modo exclusivo a la Superintendencia Nacional de Salud (Susalud) y al Instituto Nacional de Defensa de la Competencia y de la Protección de la Propiedad Intelectual (Indecopi)” (belongs exclusively to Susalud and Indecopi). How to complain to Susalud as a patient is in patient complaints to Susalud.

On refusal of care, article 40 of the regulation says:

“El incumplimiento de los establecimientos de salud de la obligación que les corresponde de prestar atención médico-quirúrgica de emergencia en caso de la ocurrencia de un accidente de tránsito, podrá ser denunciada ante la Autoridad de Salud por la víctima del accidente o sus familiares y sancionado conforme a lo dispuesto en los artículos 3 y 39 de la Ley Nº 26842, Ley General de Salud y su Reglamento.”

(If a health facility fails to give emergency medical and surgical care after a traffic accident, the victim or their family can report it to the Health Authority, and it is sanctioned under articles 3 and 39 of the General Health Law.)

Your general rights in an emergency are in emergency care rights in Peru.

Time limit to claim

Article 18 of the regulation, as amended by D.S. 009-2019-MTC, says your right to claim SOAT benefits from the insurer lapses with the limitation period for non-contractual liability claims, “conforme al numeral 4 del artículo 2001 del Código Civil” (under article 2001(4) of the Civil Code). Do not leave it for later.

What this page does not cover

We did not review the EsSalud, EPS or SIS rules on treating someone whose SOAT cover has run out, or the terms of any private policy. Nor the public hospital tariff, the reimbursement procedure between clinics and insurers, or how to calculate what you can claim from the person responsible for the accident.