Insurance regulation in Brazil is clear: there are maximum deadlines for each stage of claims processing. SUSEP (the Superintendency of Private Insurance) defines these limits and enforces compliance. Those who fail to meet them pay fines. Repeat offenders can lose their operating license.
Yet most insurers still track these deadlines manually — with spreadsheets, emails, and status meetings. The result is predictable: claims that expire without anyone noticing, avoidable fines, and dissatisfied policyholders who switch providers.
This article explains the regulatory SLAs, why manual management fails, and how to implement automated tracking per stage.
What SUSEP requires
SUSEP Circular No. 621/2020 and its subsequent updates establish maximum deadlines for claims processing across different insurance lines. The key ones:
Auto insurance - 30 days to complete claims adjustment after the policyholder submits all required documentation - If an inspection is needed, scheduling must happen within 5 business days
Life insurance and pension - 30 days for indemnity payment after complete documentation is submitted - In case of legitimate doubt, the insurer may request supplementary documents once, restarting the clock
Property insurance (residential, commercial) - 30 days for adjustment after complete documentation - Large-scale claims may have extended deadlines with formal notice to the policyholder
Health insurance (ANS) - Specific deadlines by procedure type: basic consultation in 7 business days, simple exams in 3 business days, elective surgeries in 21 business days - ANS (not SUSEP) oversees these deadlines, but the tracking logic is the same
The common denominator: all deadlines have a defined start point (usually receipt of complete documentation) and clear consequences for non-compliance.
Why manual management fails
The spreadsheet problem
A mid-sized insurer processes hundreds of claims per month. Each claim goes through stages: opening, document collection, inspection, technical analysis, approval, payment. Each stage has different owners and distinct deadlines.
When tracking is done via spreadsheet, someone must manually update the entry date for each stage. If the analyst forgets to log that documentation arrived on Monday, the official deadline starts counting from the wrong date. The manager checks the spreadsheet on Friday and thinks there are still 25 days left. In reality, there are 20.
The email problem
Email-based communication between departments creates another type of failure. The policyholder sends documentation by email. The agent forwards it to the analyst. The analyst responds three days later requesting an additional document. But no one recorded when the original documentation arrived, when it was forwarded, and when the supplementary request was made.
If the policyholder files a complaint with SUSEP, the insurer must prove it acted within the deadline. Without structured records, this proof is hard to produce.
The visibility problem
Claims managers need to know, at any moment, how many claims are approaching their SLA deadline. With spreadsheets and emails, this information requires manual compilation. By the time the report is ready, some claims have already expired.
How to measure SLAs in a structured way
1. Define the start point for each stage
The first step is eliminating ambiguity. For each stage of the claims process, define exactly what marks the beginning of the deadline.
2. Calculate time per stage
With defined start points, the calculation is straightforward: time in stage = exit date minus entry date. But the calculation must account for business days vs. calendar days, legitimate pauses, and holidays.
3. Identify bottlenecks
With time-per-stage data, you can answer questions that were previously impossible: which stage takes the longest on average, which analyst has the largest backlog, which claim type has the highest SLA risk.
4. Create aging reports
An aging report shows all open claims organized by percentage of SLA consumed: green (0-60%), yellow (61-80%), red (81-100%), and overdue (>100%). This report must be updated in real time, not once a week.
How to implement automated tracking
Escalation rules
Passive tracking (dashboards and reports) is necessary but not sufficient. Regulated processes require proactive action:
- 80% of SLA consumed: automatic alert to the responsible analyst
- 90% of SLA consumed: alert to the area manager
- 95% of SLA consumed: alert to claims leadership
- SLA expired: formal violation record, compliance notification
Real-time dashboards
An SLA dashboard for insurers should show, at minimum: total open claims by line, distribution by aging band, average time per stage over the last 30 days, SLA compliance trend, and highest-risk claims.
The cost of not tracking
Regulatory fines
SUSEP can impose fines ranging from R$ 10,000 to R$ 1,000,000 per violation, depending on severity and recurrence.
Customer loss
A policyholder who waits 45 days for a response that should come in 30 does not renew their policy. In a market where customer acquisition is expensive, retention depends directly on claims service quality.
Reputational damage
Complaints filed with consumer protection agencies and SUSEP itself are public. An insurer with a high complaint rate for delays loses position in industry rankings.
CaseFy for claims management
CaseFy was built for processes with stages, deadlines, and multiple participants — exactly what claims management requires.
- SLA per stage: each stage can have a configured SLA in hours or days
- Automatic alerts: automation rules trigger notifications when SLA thresholds are reached
- Aging reports: the aging dashboard shows all claims organized by deadline band
- Complete timeline: every action is logged with date, time, and responsible party
- External forms: policyholder documentation is collected via external forms with automatic timestamps
Regulatory requirements will not become more lenient. Deadlines will not increase. The only variable you control is the quality of your internal process.