insurance claims

General Information

The following is general information regarding insurance claims:

The Puerto Rico Insurance Industry is overseen by Puerto Rico’s Insurance Commissioner’s Office or the “Oficina del Comisionado de Seguros de Puerto Rico” (OCS). The office enforces Puerto Rico’s Insurance Code or “Código de Seguros” and its regulations thru an administrative process. The administrative processes are initiated by filing an investigation request – “invetigación” before the  OCS or a complaint or  “querella” click here, before the national Association of Insurance Commissioners.

If you file an investigation request, your case will be evaluated to determine if the OCS has jurisdiction or authority to hear your case, if so, you’ll receive a document evidencing receipt of your request and a case number. If not, you receive a notification denying your request and stating the reasons for the denial. It must be stressed, that some claims do not fall under the jurisdiction of the OCS.

An up to date summary of the OCS’s regulations can be found here. After finding the applicable regulation or regulations that apply to your instant case, visit the Puerto Rico’s State Department website, specifically its regulations registry page. On the regulations registry, use the drop down menu and select “Oficina del Comisionado de Seguros” and click “Buscar” or search. (**Note** For some reason, the search box does not work when you look for or enter a specific regulations word.) Therefore, only select the agency or “agencia”, in this case “Oficina del Comisionado de Seguros”. Once selected, a list of all current and repealed regulations will appear, look for the specific regulation that applies to your case.

Fore information regarding hurricane claims and property insurance, please visit here.

Filing a Request for Investigation

To request an investigation or to file a complaint you’ll need the following information

1. Your name, address and phone number.
2. Name of the insured
3. Detailed description of the situation
    a. ¿What Happened?
    b. ¿Who was involved?
    c. ¿Why do you believe that the insurance company or other regulated entity, committed an error or is not
        complying?
    d. ¿What actions did you take to address the issue?
    e. ¿What do you understand should be the remedies?
In case you use the Investigation form include the following documents:
1. Insurance Policy
2. Written communications your addressed to the insurance company or authorized representative.
3. Any written reply by the insurance company or authorized representative.
4. Any other written communication related to the case, including those by third parties: physicians, attorneys, etc.
Once the investigation form has been completed and is signed you can file it:

Personally at

GAM Tower
Urb.Caparra Hills Ind. Park
2 C/Tabonuco Quinto Piso (Fifth Floor)
Guaynabo PR
Not sure where this is, copy paste the address here.

By mail to

Oficina del Comisionado de Seguros
B5 C/ Tabonuco Suite 216
PMB 356
Guaynabo PR 00968-3029

Electronically by email:

investigaciones@ocs.pr.gov  Include electronic copy of your form and supporting documents.

Need more information? Please contact us we’ll be glad to help.

Last updated on Feb 19, 2018
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