Old Mutual does not adhere to its own policy definitions and timelines.

I am lodging a formal complaint against Old Mutual. The only problem is that their service is so bad that they cannot even send you their complaints departments contact details and that of the Ombudsman after asking them on numerous occasions for the details.

When lodging a claim against a policy which has been in force for years, OM also does not know how to adhere to its own policy definitions and entertains its medical officers and assessors who have no or little knowledge about some medical conditions.

This is probably because my condition is so infrequent that one would assume that they are asking Dr Google about the condition and formulating questions around the condition where there is little information online. Even ENT’s in general, do not understand the condition.

I am claiming for loss of speech, where I lost my voice when my right vocal cord became paralysed during a neck surgery. (2 years ago). I have comp**** with all the requests by OM, submitted claim forms, documents, reports etc. I have waited the “waiting periods” that OM has requested, I have gone for surgery to help my condition, had permanent prosthesis inserted (Medialisation Thyroplasty) etc in order to gain my speech.

I have been going for speech therapy, still need to go for speech therapy, possibly an adjustment to the prosthesis may need to be done. I can speak but my speech is still weak and unpredictable, it still comes and goes and my speech the****** has recommended an amplification device to make me more audible in meetings. (post-op)

I have lost income and I am not at the end of the road yet. I have not only suffered loss of speech but also shortness of breath, breathing difficulties, swallowing issues, aspirating, choking etc. Now the medical officers, in spite of definition of the condition of “total and permanent loss of speech confirmed by an ENT”, are questioning the integrity of the medical specialist that is servicing on the International boards of Otolaryngology.

I can confidently say this because Dr Lance Maron is a specialist in this field of medicine, as he has founded the “The Voice and Swallowing Centre @ Netcare Parklane Hospital” - which is a multidisciplinary centre that cares for voice and swallowing disorders. Dr Lance Maron also serves on the International Board of Laryngologists. He has formed part of the academic faculty of several international laryngology conferences and workshops and is a member of the International Association of Phonosurgery and the Voice Foundation. ENT’s refer their patients to see him when they have been unable to help their own patients with speech restoration. That should in itself, emphasize Dr Maron’s expertise and speciality. I did all my research when I was first diagnosed by another ENT, because when one is facing an infliction like this, one wants to go to someone who knows what they are doing.

The policy definition requires confirmation of loss of speech by an ENT specialist. OM has confirmation from the ENT that the loss is permanent, hence the surgery for a prosthetic, so that speech can be given. OM also has confirmation from a speech the******, recommended by his practice, that the surgery was required due to the audability without medical intervention, thereby confirming the severity.

If it was a leg that was lost, OM is not going to ask if the policyholder can walk with a prosthetic leg, you ask the question can you walk without the prosthetic, and then pay the claim. It's the same situation, just with regards to a different body part.

As such, with regards to my loss of speech, I do not understand the relevance of the post-surgical reports. This can only be seen as delayed tactics or that OM is looking for reasons not to settle this claim. Furthermore, I have requested the contact details of the complaints department as well as the Ombudsman and I am not receiving any responses. One cannot understand the complexity of losing speech, aside from when one used to sing, do Toastmasters, training etc. Without speech, one cannot communicate. It affects your relationships, your self-esteem, your communication with children and grandchildren, one becomes withdrawn. A condition like this even impacts on future surgeries etc, because there are risks with anaesthetics and intubations. The prosthesis can shift which requires more surgery and so the domino chain reaction goes.

As a result I am living in agony, I have lost income and already incurred considerable medical expenses as a result of my condition, this is causing me more stress on top of more stress.

I can understand that insurance companies are faced with ***** and *******ion, but when there is a genuine claim, OM is the most inefficient to finalise the claim. Over and above that, OM cannot adhere to its own internal deadlines and loses documents.

I just want to resolve this without any further delays and want OM to stop wasting my time. We are now way past the 18 months “waiting period” and final diagnosis. OM also likes to boast how quickly they settle valid claims and how good their payout rate is.