OBJECTIVES: Since 1997 with the Law to modernize the Social Security Health Service (EsSalud), Peru workers contribute 9% of their income in exchange for health, economic and social benefits. The workers of high-risk companies  also have a Complementary Insurance for Hazardous Work that can be purchased for the same EsSalud or private insurers. This study aims to demonstrate that regulation in the Hazardous Work Supplement Insurance is necessary because there are high-risk companies that are not regulated generate economic losses to EsSalud. METHODS: We search for all patient with pneumoconiosis diagnosis in  Social Security of Peru database, information was sought in national database of companies belonging to these workers and a review of medical records was performed to cost evaluation. RESULTS: A total of 148 patients nationwide were found. Finding 29 cases in the  La Libertad Assistance Network,  27 cases in the Assistance Network Arequipa and 25 cases in Puno-Juliaca Assistance Network (mining areas).The diagnoses found were unspecified pneumoconiosis with CIE X J64 and J64.X at 7 and 50 respectively , followed by pneumoconiosis due to dust containing silica ( J63.8 ) and Pneumoconiosis due to other specified inorganic dusts ( J63.8 ) both with 34 cases each. It was found that 70 % of the cases studied had the kind of Pensioner insurance , while 27 % had a regular insurance . There was a worker with home insurance. The costs incurred by patients in 2014 were: $  1017.62 in 2014 per patient,  $ 150609.10 in total.  CONCLUSIONS: There are high-risk companies whose workers are presenting occupational diseases who are treated as common diseases which generates costs to Social Security in Peru and should be covered by a Hazardous Work Supplement Insurance.