Declining of my legitimate disability claim and taking 3 months to respond back to me

I am very disappointed at the result of this claim which was declined yesterday. You will recall that this is the client who you requested to be seen by Dr Hoffmeyr in Cape Town…..the client did have an assessment done by this Specialist who diagnosed MENIERE’S DISEASE and in his report stated that in his opinon the client is disabled. The decline letter that I received yesterday states that the client should have informed Discovery that his occupation duties had changed due to his health issues and the policy would have been amended had they known about the changes to his occupation….yet in my email below that I sent to you dated Sept 2021…I clearly informed you about these changes…..so it is not correct to say in the decline letter that this was not disclosed or brought to Discovery’s attention. Sylvia this client is being treated very unfairly…it is a Neurologists opinion that a stroke caused the hearing problem and this is stated in the Neurologist’s report …..but the stroke cannot be clinically proven unfortunately…..it is my opinion that this client should have not only been approved for the Disability claim but a severe illness claim for the stroke should have been considered as well based on the Neurologist’s report. The decline letter states that the occupation the****** who was involved in assessing the client has confirmed that only 1 daily living category ‘s are permanent and unable to be done…..I would like to please know which activity this is? You know Sylvia…I fully understand that claims criteria have to be used to determine claims but it is situations like this claim where I am embarrassed to be a broker advising clients to take up disability….and when they are no longer able to work and are so ill , there policy means nothing….and they get reprimanded for not informing the Assurance Company of the change in their occupation…..yet this was done 2 years ago….and Discovery did nothing then to amend the policy as they have now done? I can assure you Sylvia that this client is very angry…disappointed and will not leave this as is…..I am please asking you to have this claim reviewed before things get taken further by the client ….i even sent claims a photo of the clients legs the other day ….because of his terrible vertigo he constantly falls and the bruising on his legs are **********….so how can we even contemplate that he is not disabled? Dr Hoffmeyr says he is disabled and he is the best E& T in the country…yet Discovery are declining the claim….and loading the policy for non disclosure …even when the Head of Claims was made aware that the occupation had drastically changed. Any assistance you can please offer will be greatly appreciated. Thanks steve Orom: Steve Smith [mailto:***] Sent: 10 September 2021 09:43 AM To: Sylvia Steyn (***) Subject: Please Assist / pol number : *** / client Mr A Y MAHOMED Hi Sylvia, Hope that you and your family are all keeping well during these challenging Covid times we are living through at present. Please can I ask you to assist me with a client who I have only recently been linked to as the new broker. The client had a heart related claim in 2020 which resulted in a 100% approved pay out from his Severe Illness benefit. Immediately following his triple heart bypass procedure the client experienced loss of hearing that triggered a second claim against his Severe Illness and Capital Disability benefits…..this hearing loss claim was declined due to the clinical criteria not being met …..which I can fully accept. However I feel very strongly that a Category D claim for this client should have been approved as the client is not able to perform his occupational duties that he used to do before he suffered his loss of hearing. I have read through all of the Specialist reports that were obtained from his treating Neurologist, his ENT Specialist as well as the report from an audiologist who performed the tests to confirm the clients loss of hearing levels. It is clear from these reports that these specialists also confirm that the client is in terms of his occupation severely disabled and functionally impaired. The Neurologist is of the opinion that the client actually suffered a stroke ( see attached report ) that has caused the loss of hearing. We should probably be also investigating if this client should also have a claim for stroke against his Severe Illness benefit? The E N T has stated in his report ( see attached) …’ Speech recognition scores of 43-47% in the right ear indicate a disabling hearing impairment from the right ear which cannot be improved by using a hearing aid. The auditory system cannot process the speech information however loud it is made. From a medical perspective, this disabling hearing loss which results in severe incapacitation in his ability to communicate in any environment other than one to one communication without any background noise. This means that his ability to work in his shop, with significant background noise is compromised. This has a negative impact on his work of listening and dramatically increases his stress and anxiety levels.” Sylvia, I visited the client for the first time since I have been appointed as his new broker as the client resides in PE and I am based in EL. The client was unable to meet with me at his shop because he cannot hear well enough in that environment as the is significant background noise making it impossible for him to liaise with his customers. Since the hearing loss problem has occurred the client’s spouse now has to take over the role of front office communications with all incoming customers, and my client now has to remain in the back office where his role has changed completely to that of a technical repair nature…where prior to the hearing loss he was the life of the business, developing good relationships with his customers . When I met with the client we had to find a quite coffee shop so that we could communicate and even in this environment, compounded by the issue of wearing masks, the client frequently failed to hear what I was saying and I had to repeat myself so that the client could decipher what I was communicating. The reason I am sending this directly to you Sylvia is that I honestly feel that we have done an injustice to this client by declining his hearing loss claim….and as I have mentioned above we possibly should even be considering a stroke related claim as well. Please relook at this claim with a view to approving a Cat D as this client is certainly not able to perform his role as a Business Owner in the manner that he was able to prior to his life changing event that has occurred and affected his life so significantly. Many Thanks, Steve