Resolution SBS No. 04036-2022: Approves the Claims and Requests Management Regulation

Lima, December 28, 2022
Resolution S.B.S.
No. 04036- 2022

The Superintendent of Banks, Insurance and Private Pension Fund Administrators

CONSIDERING:

That, pursuant to Article 345 of Law No. 26702, General Law of the Financial System and of the Insurance System and Organic Law of the Superintendence of Banks and Insurance, the Superintendence protects the interests of the public in the field of financial and insurance systems; and pursuant to paragraph d) of Article 57 of the Single Text of the Law of the Private System of Administration of Pension Funds, approved by Supreme Decree No. 054-97-EF and its modifying norms, it regulates the functioning of AFPs and the granting of benefits they provide to their affiliates;

That, pursuant to Article 88 of the Consumer Protection and Defense Code, Law No. 29571 and its modifying norms, entities of the financial and insurance systems receive, register and resolve complaints in the manner and time limits determined by the norms of the Superintendence of Banks, Insurance and AFP;

That, Circular G-184-2015, User Attention Circular, regulates the process of attention to complaints and requests from users of companies in the financial system, insurance and private pensions;

That, important changes and advances have occurred in financial services as a result of technological innovation in an environment of greater digitalization, which have also been accelerated as a consequence of the pandemic originating from COVID-19;

That, the aforementioned changes and advances have been reflected in the interaction between companies and their users, both in the manner and in the channels used for the contracting and execution of financial products and services, as well as in the reception, attention and resolution of complaints and requests; therefore, it is considered necessary to update the regulatory framework in order to incorporate the new forms of interaction between the supervised companies and their users, as well as between the companies and this Superintendence, including the mechanisms for access and reporting of complaint and request information;

That, the regulatory framework on complaints was recently modified to adapt certain provisions applicable to those companies under the scope of the Special Regulation for the Management of Market Conduct of the Financial System, approved by SBS Resolution No. 2304-2020, so it corresponds to consolidate them in a single legal device for the management of complaints and requests of the supervised systems;

That, Law No. 31143, Law that protects consumers of financial services from usury, has established new obligations for companies in the financial system, associated among other aspects, to the collection of commissions and expenses for users, to the prohibition of the collection of penalties, and to the establishment of limits on the application of interest rates; therefore, it corresponds to adapt the reasons and sub-reasons for complaints applicable to such scenarios to facilitate their registration, as well as the development of the supervision activities of this Superintendence;

That, by Legislative Decree No. 1531, Law No. 26702, General Law of the Financial System and of the Insurance System and Organic Law of the Superintendence of Banks and Insurance, was modified, and it was established among other aspects, that companies can carry out digitally all operations for which they are authorized, eliminating the obligation of financial system companies to have physical agencies for user attention, so it corresponds to adapt the enforceability of physical agencies as a channel for the presentation of complaints and requests, unless this is the only channel;

That, for the purpose of collecting the opinions of the general public, the pre-publication of the draft resolution was ordered on the electronic portal of the Superintendence, under the provisions of Supreme Decree No. 001-2009-JUS;

Having the approval of the Deputy Superintendencies of Banks and Microfinance, Insurance, Private Pension Fund Administrators, Legal Advisory, and Market Conduct and Financial Inclusion; and,

In exercise of the attribution conferred by numeral 9 of Article 349 of Law No. 26702, General Law of the Financial System and of the Insurance System and Organic Law of the Superintendence of Banks and Insurance; and by paragraph d) of Article 57 of the Single Text of the Law of the Private System of Administration of Pension Funds approved by Supreme Decree No. 054-97-EF and its modifying norms;

RESOLVES:

First Article.- Approve the Regulation for the Management of Claims and Requests, as indicated below:

“REGULATION FOR THE MANAGEMENT OF CLAIMS AND REQUESTS”

CHAPTER I
GENERAL ASPECTS

Article 1. Scope
The provisions of this regulation are applicable to the companies indicated in letters A, B and D of Article 16, and in Article 17 of the General Law, as well as to the National Bank, to the Agricultural Bank, to the Derramas and Benefit Boxes, to the Associations of Regional or Provincial Funds against Traffic Accidents (AFOCAT), as well as to Private Pension Fund Administrators (AFP), hereinafter referred to as the companies.

Article 2. Definitions
For the purposes of the provisions of this Regulation, the following definitions and references must be considered:

1. Companies: those considered in the scope of Article 1.
2. General Law: General Law of the Financial System and of the Insurance System and Organic Law of the Superintendence of Banks and Insurance, Law No. 26702 and its modifying norms.
3. Product and/or service: product and/or service of the financial, insurance and/or pension system or accessory or auxiliary service.
4. Regulation: Regulation for the Management of Claims and Requests.
5. Regulation or Market Conduct Management Regulations: Financial System Market Conduct Management Regulation, approved by SBS Resolution No. 3274-2017 and its modifying norms; and/or Insurance System Market Conduct Management Regulation, approved by SBS Resolution No. 4143-2019 and its modifying norms, as applicable.
6. Superintendence: Superintendence of Banks, Insurance and Private Pension Fund Administrators - SBS.
7. User: natural or legal person who uses or may use the products and services offered by the companies.

Article 3. Complaints and requests management system

3.1 The complaints and requests management system must include policies and procedures that define the criteria and indicators associated with the comprehensive administration of complaints and requests in companies and their processing; considering for this, a timely and objective attention to the communications presented by users, and the issuance of responses to users regarding all aspects of the complaint and/or request in a clear, substantiated and simple manner.

3.2. The management is responsible for implementing measures that allow mitigating deficiencies in products and services that have generated user complaints, as well as their consequences; reducing the probability of the entry of new complaints linked to the same cause.

CHAPTER II
ATTENTION OF COMPLAINTS

Article 4. Processing of complaints

4.1 Complaints are communications presented by users or third parties on behalf of users, related only to contracted products and services, or to operations associated with them, in which they express their dissatisfaction with the received operation, product or service or with the non-compliance with the obligations contemplated in the contracts or in the current regulatory framework, or manifesting the alleged affectation of their legitimate interest.

4.2 Additionally, a complaint is considered any repetition that originates as a consequence of the user's disagreement with the response issued by the company, or due to the delay or lack of attention to a complaint or request.

1 Paragraph modified by SBS Resolution No. 3240-2023 of 03/10/2023.

4.3 Companies must have internal procedures for the attention of complaints that establish as a minimum, the following:

a) The channels made available to users, for their presentation, considering what is indicated in paragraph 8.1 of Article 8 of this Regulation.

b) The procedure for its reception, registration, analysis, response and follow-up, which include the presentation requirements, internal time limits and interaction with other areas or entities.

c) The procedure for the attention of a third party who presents the complaint on behalf of the user. The third party does not require proof of representation and the response to the complaint must be sent by the company to any of the channels registered by the user for this purpose.

d) The procedure for the physical or digital archiving of documentation and the designation of those responsible for its conservation.

e) The identification of complaints that, due to their characteristics, according to the internal policies of each company, will always be resolved in favor of the user without the need to perform prior analysis.

f) Criteria for the registration and typification of complaints presented by users according to the codes of the Annexes of the Complaint Reports - CR.

g) Controls to verify the correct registration and typification cited in the previous letter.

h) Additional aspects indicated in the Regulation, associated with the registration and reporting of complaint information.

4.4 Companies must implement, as a minimum, channels a) -if they have this- and c) indicated in paragraph 8.1, to receive and derive the supporting information of the received complaints, regardless of the channel used for its presentation. Companies must inform the user of the channels through which the support for complaints can be presented.

4.5 Companies must have a complaints database containing as a minimum the information indicated in Annex No. 1-A, which must be kept updated in such a way as to allow adequate follow-up of the attention provided, regardless of the channel used for the presentation of the complaint.

4.6 Companies must have a backup system, which can be physical or digital, for those exceptional situations of force majeure or fortuitous event, in which the user's complaint cannot be registered through the mechanism originally established by the company. Once the mechanism for registering complaints is re-established, all complaint information stored in the backup system must be transferred to the database indicated in paragraph 4.5.

4.7 For the case of companies authorized to issue credit and/or debit cards and/or electronic money, the availability of complaint reception and attention channels, and those implemented for users to communicate the loss or theft of the medium used to operate with the aforementioned products and/or the information contained in them, must be guaranteed, so that the unavailability of one channel does not affect the availability of the other.

Article 5. Area and Responsible for the attention of complaints

5.1 Companies must have an area responsible for the attention of complaints, which must have the adequate human, material and technological resources to fulfill its functions. Companies must adopt the necessary actions so that personnel have knowledge of the applicable norms, policies, procedures and internal time limits for user attention established by the company.

5.2 The General Management must designate a main responsible and an alternate responsible for the attention of complaints in the company, regardless of the organizational scheme used. Their designations and the date of commencement of their functions must be reported to the Superintendence within five (5) calendar days of occurrence. The Superintendence may establish through Multiple Office the sending mechanisms, as well as request additional information associated with such designations.

5.3 The responsible for the attention of complaints, as well as the alternate in the absence of the holder, are in charge of the following functions:

a) Ensure the implementation and compliance with the company's policies and procedures regarding the complaint attention system.

b) Attend and/or ensure the correct attention of the complaint in all its stages: reception, registration, analysis, response and follow-up.

c) Prepare the management reports referred to in Article 12, as well as ensure compliance with this Regulation.

d) Coordinate permanently with the Market Conduct Officer (MCO) on the aspects regulated in this Regulation, in the case of companies included in the scope of application of the Market Conduct Management Regulations.

e) Attend the requests made by the Superintendence, in order to respond to the complaints presented by users of the companies, within the framework of SBS Resolution No. 4464-2016.

CHAPTER III
ATTENTION OF REQUESTS

Article 6. Processing of requests

6.1 Requests are communications made by users or third parties on behalf of users, for which an action by the company is sought, comprising the following aspects:

a) Inquiries: understood as communications for which it is sought that the company provide specific information in a situation of uncertainty, ignorance or doubt related to the operation, product or service offered or contracted with the company.

b) Requests for delivery or making available information and/or documentation that the company possesses regarding the relationship it maintains or maintained with users.

c) Other requests different from those indicated in letter b), as long as they are not in the situations indicated in paragraph 6.2.

6.2 The following cannot be considered or registered as requests:

a) Aspects related to complaints, according to what is indicated in paragraphs 4.1 and 4.2.

b) Aspects specific to the execution of contracts (such as account operations, coverage of claims, payment of pension or insurance premiums, among others); the modification of contracts and the exercise of the right to resolve contracts.

c) The request and contracting of new products and/or services.

6.3 Companies must have internal procedures for the attention of requests that establish as a minimum the following:

a) The specification of the responsible for the attention of requests, which can be the same as referred to in paragraph 5.2. The support for its designation must be kept available to the Superintendence.

b) The channels made available to users for their presentation.

c) The procedure, attention time limits and channels established to respond to requests.

d) The types of requests that can be attended immediately at the time they are made.

e) The procedure for the attention of a third party who presents the request on behalf of the user. The third party does not require proof of representation and the response to the request must be sent by the company to any of the channels registered by the user.

f) The procedure for the physical or digital archiving of documentation and the designation of those responsible for its conservation.

g) Criteria for the registration and typification of requests presented by users.

h) Controls to verify the correct registration and typification cited in the previous letter.

i) Additional aspects indicated in the Regulation, associated with the registration and reporting of request information.

6.4 Companies must have a requests database containing as a minimum the information indicated in Annex No. 1-B, which must be kept updated in such a way as to allow adequate follow-up of the attention provided, regardless of the channel used for the presentation of the request. Those requests that are attended at the time they are made do not require the mentioned registration; unless, when presenting the request, the user requests a written response in the form established in paragraph 10.1.

CHAPTER IV
PROCESS OF ATTENTION OF COMPLAINTS AND REQUESTS

Article 7. Calculation of time limits

7.1 Complaints must be resolved by companies within a maximum period of fifteen (15) working days. Exception to micro-insurance complaints, which must be resolved by companies within a maximum period of fifteen (15) calendar days, according to the regulations on the matter. 2

7.2 Requests, with the exception of those situations in which general character norms establish maximum time limits for their attention, must be resolved by companies within a maximum period of fifteen (15) working days from their presentation. 3

7.3 Companies must comply with communicating to users the response to complaints and requests within the time limits established in paragraphs 7.1 and 7.2. These time limits may be extended, exceptionally, as long as, due to the nature of the complaint or request, they require the prior pronouncement of a third party. This extension must be communicated to the user within the mentioned time limit, explaining the reasons for it, as well as specifying the estimated response time. 4

7.4 Companies must establish mechanisms that allow them to have the necessary information to attend to complaints and requests within the maximum time limits established. 5

7.5 The calculation of the time limit for the attention of complaints and requests starts from the next working day after their presentation to companies, until the date of notification or making available the response by these, through the channel agreed upon at the time of its presentation. The company must have the corresponding support for the notification or making available. 6

7.6 Attention resolved in favor of the users and communicated to them before the calculation of the time limit has begun, independently of the term of the corresponding regularization, do not generate for companies the obligation of dissemination and reporting contemplated in paragraphs 15.2 and 16.1 of the 2 Provision effective from 28.02.2023 3 Provision effective from 28.02.2023 4 Provision effective from 28.02.2023 5 Provision effective from 28.02.2023 6 Provision effective from 28.02.2023 Regulation. Nevertheless, companies must incorporate them in the database cited in paragraph 4.5 and keep available to this Superintendence the support of each of these attentions.

7.7 Companies must have the support for the attention of all their complaints, which must be kept available to the Superintendence. In case it is established, as part of the application of internal policies of companies, that certain types of complaints will be declared in favor of the client without the need to perform prior analysis, the manuals that collect these policies can be considered as support. 7

7.8 It is understood that a complaint has been resolved in favor of the user, when in all its aspects they have been attended in their favor, without any controversy remaining regarding the facts exposed in the complaint. In the case of complaints for operations not recognized by the user, with monetary impact, that are in process at the time of reporting to the Superintendence, these are considered resolved for the purposes of said reporting, if the company grants temporary refunds for the total amount claimed, regardless of the final result that the case might have, after the respective analysis.

Article 8. Attention and response channels

8.1 Companies must make available to users, as a minimum, the following channels for receiving complaints: a) the network of customer service offices, if they have these; b) by telephone; and c) their digital channels, such as website, links in mobile device applications, messaging applications, among other similar, if they have these. In the case of requests, companies must make available to users, as a minimum, the network of customer service offices, if they have these, and an additional channel from those listed for the reception of complaints. 8

8.2 Companies must implement channels for responding to complaints and/or requests that cover as a minimum: a) the making available in the agency, b) the sending of the response to the user's home address and c) a digital channel (such as email, mobile device application, messaging applications, among other similar). The user freely chooses the channel of their preference, among these options. In the cases of complaints and/or requests entered through a digital channel, the company may establish said channel as the only option to communicate the response to the user.

Article 9. Registration, analysis and response to complaints

9.1 At the time of the presentation of complaints, companies must register the user's identification data and those necessary to be able to effect the notification of the response. Once the available response channels for complaints are informed, except for the exception indicated in paragraph 8.2, the channel chosen by the user is registered. In case the user does not indicate the channel to receive the response to the complaint or in case it is presented by a third party, the company sends it to the home address or email registered by the user.

9.2 When the complaint is presented in a customer service office, the company must deliver to the user a report containing as a minimum the following information:

a) Date and time of the presentation of the complaint.

b) Identification of the company

c) Estimated date of response.

d) Complaint code.

e) Response channel, according to user's choice.

f) User identification data, including those necessary to notify the response.

7 Provision effective from 28.02.2023
8 Paragraph modified by SBS Resolution No. 4320-2025, of 04.12.2025.

g) Description of the operation, product, and/or service linked to the claim. h) Detail of the claim and/or request from the client.

9.3 In the event that the claim is presented through a channel different from that indicated in paragraph 9.2, the code of the claim, the date, and time of its presentation must be communicated to the user at the moment of its presentation. The company must make available to the user the report with the data indicated in paragraph 9.2 in the channel chosen by the user to receive the response to the claim, as provided in paragraph 9.1, no later than the next business day following the presentation of the claim.

9.4 Companies may require the user to provide specific or complementary documentation or information regarding aspects related to the claim, provided they do not have this or cannot obtain it substantiatedly, granting a period of no less than two (2) business days for its presentation, informing the user of the consequences derived from failing to present the requested information in this paragraph. During this period, the attention deadline indicated in paragraph 7.1 of Article 7 is suspended, and companies must guide users in obtaining such documentation. The resumption of the deadline occurs upon the expiration of the period granted by the company or from when the company receives the information sent by the user, whichever occurs first. If, after said period has expired, the user fails to comply with what was required, companies may proceed with the annulment of the claim, without prejudice to maintaining its record.

9.5 In case the user presents repetitive communications regarding the same claim, its record must be linked to the previous claim, in accordance with what is stated in Annex 1-A of the Regulation.

9.6 The communication of response to the claim must consider as minimum the following information:
a) Identification of the user. b) Claim code. c) Product reference (contract number or policy number and/or certificate number or code of the Private Pension System (SPP) of the affiliate, if applicable; as well as product name). d) Explicit indication of whether the claim is attended in favor of the user or the company. e) Description of the response, considering the particular elements of the claim and/or the operation performed by the user. f) Instances to which the user may resort if not satisfied with the response, such as the National Institute for the Defense of Competition and of Intellectual Property Protection – INDECOPI; the Superintendence, in the case of claims related to aspects concerning the SPP; and the National Superintendence of Health – SUSALUD, in the case of claims related to aspects concerning health risk coverages; as applicable. g) Regarding claims not resolved in favor of the user, companies must justify and support the response provided to the user and make the supporting documentation available.

Article 10. Registration and response to requirements

10.1 At the time of presenting the requirement, for those cases where the user requests the response in writing, companies must require that the reception channel for the response be indicated, considering the channels and other aspects indicated in paragraph 8.2. To this effect, they must previously inform users of the channels established to respond to their requirements so that they can choose the applicable channel. In case the user does not indicate the channel to give response to the requirement, the company will send it to the home address or to the email registered by the user.

10.2 For the attention of requirements, AFPs must apply what is established in the Compendium of Norms of Regulatory Superintendence of the SPP and other norms issued by the Superintendence applicable to the SPP, regarding their attention.

Article 11. Support and filing of claims and requirements

11.1 In case the responses to claims and requirements are sent to the home address, the company must conserve the receipts of the communications sent, in accordance with what is established in the General Law. If sent via digital channel, the company must conserve the proof of sending the response to the claim. The notification of the response to the home address of users must consider the following:
a) The delivery receipt must attest to the names and surnames of the person receiving the communication, the type and number of their identity document and/or their relationship or kinship with the user, their signature, as well as the date on which the notification is made. b) If the person receiving the communication refuses to sign the receipt of reception of the notification, or if – having made a first attempt, duly evidenced – the person who can receive the referred document is not found at the domicile, the notification must be left under the door, leaving a record thereof in the respective receipt, consigning the date, time, and main characteristics of the facade of the property.

11.2 Companies must implement mechanisms that allow adequate filing of claim and requirement files, which must contain the documentation that supports the attention and follow-up provided in each particular case; with the exception of claim cases that have been declared in favor of the client as a consequence of the application of internal policies; and, of requirements attended at the moment they are made.

CHAPTER V
CLAIMS AND REQUIREMENTS MANAGEMENT

Article 12. Management indicators and reports

12.1 Companies must implement indicators and alert thresholds that strengthen the management of the system for attending to claims and requirements. The Superintendence may define indicators and thresholds related to the management of claims and requirements complementarily to those determined by the company.

12.2 The manager of the claims attention area prepares as minimum quarterly reports on the evolution of the attention of claims and requirements, indicating, at least, the following aspects:
a) The operations, products, or services that are the object of the highest number of claims and/or requirements, the average attention time, as well as the analysis of the main reasons or causes that have generated said claims. b) Evolution of the indicators established in paragraph 12.1 in relation to their thresholds. c) Corrective measures and/or improvement opportunities identified from the analysis of the cause of the claims and the results of the follow-up to management indicators, as well as the dates and responsible parties for their implementation. d) Results of the follow-up to the implementation of corrective measures and/or improvement opportunities corresponding to previous reports; as well as actions to be proposed to Management in case of delays in their execution. e) Others indicated by the Superintendence.

12.3 The preparation of said reports must be coordinated with the involved areas and made known to the General Management and to the managements of the referred areas, as well as to the Market Conduct Officer of the company, as applicable.

Article 13. Training

13.1 Companies must elaborate an annual training plan for personnel in charge of attending to claims and/or requirements, which includes aspects related to the regulatory framework applicable to said companies, norms in matters of market conduct and consumer protection, as well as regarding their functions. Said plan is submitted for prior consideration to the Board of Directors, and approved by them before December 31 of each year.

13.2 For those companies included within the scope of the Market Conduct Management Regulations, the aforementioned annual training plan may be included in the Annual Work Program of the Market Conduct Officer.

13.3 In case modifications occur to the current regulatory framework in matters of market conduct and consumer protection, or other relevant normative aspects, the corresponding training must be provided to the personnel in charge of attending to claims and/or requirements regarding said modifications.

CHAPTER VI
DISSEMINATION AND REPORTING OF INFORMATION

Article 14. Information to the user

14.1 Companies must keep available to users, through their digital channels, and in all their establishments open to the public, in a visible and easily accessible place, information, posters, and/or brochures about the procedures for attending to claims and requirements, the requirements for their processing, attention deadlines, the channels made available to users for their presentation, and channels for the reception or making available of the response.

14.2 Companies must keep available to the public informational material granted by the Superintendence regarding the work they perform, with the purpose of informing about their competencies in attending to claims or requirements related to the products and/or services provided by the companies; which may be disseminated through any of their attention channels.

14.3 Companies must implement dissemination mechanisms through mass channels that seek to prevent fraud incidents that have been identified from the analysis of claims, where security measures that users must adopt to mitigate their occurrence are indicated.

Article 15. Dissemination of statistics by the company

15.1 Companies must disseminate, through their website, in the portal or specific zone where information associated with products and services offered to the user is disseminated, in a prominent and easily accessible manner for users, the statistical information relative to the claims presented by users.

15.2 The information to be disseminated must show the total of claims attended by the company in each period reported to the Superintendence. For the dissemination of the information, the following is considered:
a) It does not include repetitive claims. b) It is classified by the ten (10) operations, products, or services that, most frequently, are the object of complaint. c) It allows identifying and highlights the three (3) most frequent reasons for complaint. d) It allows distinguishing the number of claims that were solved in favor of the user and in favor of the company. e) It includes the average attention time. f) It includes the total number of operations of the company. g) It is consistent with the information from the claim reports No. RR1, RR2, and RR3 sent to the Superintendence. h) It does not include communications registered under product code 112 and reason 39, as they are not linked to the contracted products and services, or to the operations associated with these.

15.3 The information published on the company's website must consider a period of no less than 2 years, according to the frequency of the report.

15.4 Companies may show on their website, separately from that cited in paragraph 15.2, the information relative to claims that have been declared admissible, as a consequence of the application of the internal policies indicated in letter d) of paragraph 4.3, if applicable.

Article 16. Report to the Superintendence

16.1 Companies must report monthly to the Superintendence, within fifteen (15) calendar days following the closure of each month, the statistics of the claims presented by their corresponding users. These statistics must consider information referring to the number of claims received, number of claims attended (in favor of the user and in favor of the company), average attention time, the products, reasons, and sub-reasons for claims, the number of claims in process, and the total number of operations of the company in the last period.

16.2 The statistics must be sent to the Superintendence via the Sub-module for Capture and External Validation (SUCAVE), using, as applicable, the claim reports No. RR1, RR2, and RR3 which are presented as Annex No. 2 of the Resolution. To this end, the code tables included as annexes of the Resolution, as well as their respective guidelines, must be taken into account.

16.3 The update of the code tables indicated in the previous paragraph is published on the Superintendence's website (https://www.sbs.gob.pe/) and communicated to companies via Multiple Office Notice, for the corresponding report.

16.4 Regarding companies to which sending through SUCAVE does not correspond, they must remit the claim statistics in an Excel file, to the mailbox estadisticasreclamos@sbs.gob.pe, with the fields indicated in Annex No. 2.

16.5 Companies must have mechanisms that allow extracting the information contained in the databases of claims and requirements indicated in paragraphs 4.5 and 6.4 of this Regulation, for purposes of periodic reporting.

17. Answering consultations in a group or guild manner

17.1 Companies may organize themselves in a group or guild manner to answer and attend to user queries, provided there is no doubt regarding the identity and responsibility that corresponds to the company to which the query is directed and which receives the query. In this case, it must be brought to the knowledge of the Superintendence within a period no greater than fifteen (15) calendar days from having decided on the implementation of said system. Companies must inform within said period about the established attention procedures, as well as what is established in their organization and function manuals for this type of query attention.

CHAPTER VII
PROPORTIONAL TREATMENT

Article 18. Proportional treatment

18.1 The companies indicated below, due to their size and particular characteristics, are subject to the provisions established in this Chapter:
a) Those included in letter B of Article 16 and in Article 17 of the General Law, as well as insurance companies that commercialize exclusively Collective Disability and Survival Insurance – SISCO. b) Distributions and Benefit Funds. c) Associations of Regional or Provincial Funds against Traffic Accidents (AFOCAT).

18.2 The following provisions apply to the companies indicated in paragraph 18.1:
a) For the presentation of claims, companies must make available to users as minimum: a) the network of public attention offices, if they have them; and an additional channel from those listed in paragraph 8.1 of the Regulation. b) For the presentation of requirements, companies must make available to users the network of public attention offices. In case they do not have them, they must deploy one of the channels listed in paragraph 8.1 of the Regulation. c) The tasks of attending to claims and requirements may be entrusted to an area or official of the company that performs other types of functions, provided that it is ensured that this does not generate conflicts of interest. d) Companies must elaborate an annual report on the evolution of the attention of claims and requirements, to which reference is made in paragraph 12.2 of the Regulation. e) The other provisions of this Regulation.

Article 19. Request for proportional treatment

19.1 Exceptionally, those companies not included in paragraph 18.1 of the Regulation may request prior authorization from the Superintendence for the provisions established in paragraph 18.2 to apply to them, due to their nature, size, and the complexity of their products and services; and always that the volume and evolution of claims and the applied policies justify it.

19.2 In the request for proportional treatment presented by the companies referred to in the previous paragraph, the following documents must be attached:

1. Report supporting the application of the proportional treatment regime considering the nature, size, and complexity of the products and services they commercialize to users.
2. Detail of the channels that will be available to users for the presentation of claims and requirements.
3. Description of whether the tasks of attending to claims and requirements will be entrusted to an area or official of the company that performs other types of functions or if they are in charge of an area or official exclusively.
4. In case the tasks of attending to claims and requirements are performed non-exclusively, the analysis of compatibility of functions ensuring that there are no conflicts of interest between these, as well as the detail of the functions of each position.
5. Last four quarterly management reports on claims.

19.3 If, in the exercise of its supervision powers, the Superintendence determines that the proportional treatment implemented by the company does not allow adequate management of claims and/or requirements, it may leave without effect the authorization granted under paragraph 19.1.

FINAL COMPLEMENTARY PROVISIONS
First.- The authorizations to not have exclusive areas for attending to claims and/or not to have some channel for the presentation of claims, granted under the provisions of Circular G-184-2015, User Attention Circular, as well as the designations of the titular and alternate responsible for attending to claims, maintain their validity. Second.- What is established in this regulation does not exempt compliance with other applicable provisions referred to claims and requirements, comprised in the Consumer Protection and Defense Code, Law N° 29571 and its modifying norms, and in the Regulation of the Complaint Book approved by Supreme Decree N° 011-2011-PCM and its modifying norms. Likewise, companies must maintain a record of all complaints presented by users, in compliance with what is stated in the Regulation of the Complaint Book. To this end, they may use the database required in paragraph 4.5 of Article 4 of this regulation, under product codes 112 and reason 39.

Article Second.- Modify the denomination of Title VI of the Regulation of the Special Regime for the Management of Market Conduct of the Financial System approved by Resolution SBS N° 2304-2020:
“TITLE VI
Provisions for Electronic Money Issuing Companies”

Article Third.- Modify Article 42 of the Regulation of Supervision and Control of Insurance Brokers and Auxiliaries, approved by Resolution SBS N° 809-2019 and its modifying norms, according to the following text:
“Article 42. Attention of claims
42.1 To insurance brokerage companies belonging to segments 1 and 2, the following provisions of the Claims and Requirements Management Regulation, approved by Resolution SBS Nº 04036-2022, apply:

1. Article 4, with the exception of paragraph 4.7. To determine the provisions linked to the channels made available to users for the presentation of claims, applies numeral 1 of paragraph 42.4 of this article.
2. Paragraph 7.1 of Article 7.
3. Paragraph 8.2 of Article 8.
4. Articles 9, 11, and 14, with the exception of paragraph 14.3.
5. Paragraph 16.1 of Article 16. The information on claim statistics is sent in Excel file, through the Electronic Supervision Platform or the means determined by the Superintendence, with the fields indicated in Annex No. 2 of the Claims and Requirements Management Regulation.
6. Letter c) and d) of paragraph 18.2 of Article 18.
   42.2 Insurance brokers belonging to segment 3 must register claims according to what is stated in paragraph 4.5 of the Claims and Requirements Management Regulation, and keep the support of their attention available to the Superintendence.
   42.3 Additionally, all insurance brokers must:
7. Transfer the claim related to the product contracted by the insured to the insurance company, if the claim is against the latter, within a maximum period of two (2) business days.
8. In case the insurance broker interposes a claim on behalf of the insured, they must deliver to the insured the proof of presentation of the claim issued by the insurance company, within a period no greater than two (2) business days, counted from the reception of the proof, and perform follow-up on the timeliness of the response to the insured.
   42.4 Insurance brokers belonging to all segments must comply with the following:
9. Make available to policyholders and/or potential insured persons as minimum one of the following channels for reception of claims:
   a) Network of public attention offices, if they have them. b) Telephone line; or c) Digital channels (email, website, mobile device applications, among others.)
10. Apply the attention deadlines indicated in the Claims and Requirements Management Regulation.
11. Deliver a copy of the report referenced in paragraph 9.1 of Article 9 of the Claims and Requirements Management Regulation.
12. Maintain the proof of notification of the response to the claim.”

Article Fourth.- The annexes that form part of the Resolution are published on the institutional portal (www.sbs.gob.pe), in accordance with what is disposed in Supreme Decree N° 001-2009-JUS and its modifying norms.

Article Fifth.- Incorporate into the Single Text of Administrative Procedures of the Superintendence of Banks, Insurance, and Private Pension Fund Administrators, approved by Resolution N°1678-2018 and its modifying norms, procedure No. 206 “Authorization to apply the proportional treatment regime for the Management of Claims and Requirements”, according to the text attached to this resolution and published in accordance with what is disposed in Supreme Decree N° 004-2008-PCM, Regulation of Law N° 29091, on the institutional portal (www.sbs.gob.pe).”

Article Sixth.- Incorporate into Annex 1: Common Infractions of the Regulations on Infractions and Sanctions of the Superintendence of Banking, Insurance and Private Pension Fund Administrators, approved by SBS Resolution No. 2755-2018 and its modifying norms, the following:

I. Minor Infractions

30. Not including in the claim report and/or in the response communication to the user, the minimum information established in the current regulations.

II. Serious Infractions

79. Not having the databases of claims and/or requests, and/or not keeping them updated, according to the content established in the current regulations.

80. Not having a backup system for claims, in accordance with what is established in the regulations.

81. Not delivering or making available to users, the report of presentation and claim code when it is presented in a channel other than the office, from a significant sample reviewed by the Superintendence.

Article Seventh.– Modify Annex 1: Common Infractions of the Regulations on Infractions and Sanctions of the Superintendence of Banking, Insurance and Private Pension Fund Administrators, approved by SBS Resolution No. 2755-2018 and its modifying norms, the following:

I. Minor Infractions

8. Not complying with attending to claims and/or requests presented by users, including those of potential pensioners, in accordance with the procedures and/or within the deadlines established by the current regulations.

9. Not keeping available to the public or providing incorrectly, the information regarding the procedure for attending to claims and/or requests, and/or not disseminating or disseminating incorrectly the statistics of claims, in accordance with what is established in the current regulations.

II. Serious Infractions

61. With respect to the management of claims and requests:

a) Not implementing and/or failing to comply with the policies and procedures established by the company related to the comprehensive administration of claims and requests.

b) Not complying with the elaboration of management reports and/or that these do not comply with the aspects required in the current regulations and/or that they are not communicated to the areas of the company indicated in said regulations.

62. Not having the channels for receiving and/or responding to claims, in accordance with the current regulations.

Article Eighth.- This Resolution enters into force on January 1, 2024, being that month the first period to report according to what is indicated in article 16 of the Regulations. Upon the entry into force of the aforementioned Regulations, Circular G-184-2015, Circular on User Attention, and Chapter I of Title VI of the Regulations of the Special Regime for the Management of Market Conduct of the Financial System approved by SBS Resolution No. 2304-2020 are repealed; with the exception of paragraphs 7.1, 7.2, 7.3, 7.4, 7.5 and 7.7 of article 7 of these Regulations which enter into force 60 calendar days after the publication of this Resolution.

Register, communicate and publish.
MARIA DEL SOCORRO HEYSSEN ZEGARRA
Superintendent of Banking, Insurance and AFP