Old mutual resolute on not paying client

A week ago Consumer Line published an article highlighting the plights of Kaizer Mayindi and Jacob Kgamphe, whose claims were rejected by Old Mutual on the grounds that they were not "totally and permanently disabled".

Mayindi, who suffers from a chronic obstructive lung disease, gout, hypertension, acute anxiety attacks and type two diabetes, was laid off in 2012 by Sasol's medical practitioner due to ill health.

Elton Fortuin of Sasol confirmed that Sasol could not retain Mayindi as an employee due to the suspension of his professional driver's permit owing to his poor health.

Sasol could not get him alternative employment within the company when they laid him off and paid him an ex gratia benefit when Old Mutual rejected his disability claim.

But Old Mutual said Sowetan' s previous article omitted to state the fact that Sasol's occupational medicine practitioner found that Mayindi was unable to perform his current job as a driver, but did not find that he was unable to be in another occupation.

Old Mutual spokeswoman Lisette Lombard said Mayindi's specialist reported that on the grounds of his examination in January 2014, he could not find grounds for permanent disability and that his conditions was treatable with medication.

Mayindi pointed out that the treatment had not helped improve his health in the past three years.

He said although he even obtained a second opinion from another practitioner who said he was permanently disabled and could not perform any other duty, Old Mutual still rejected his claim.

Though Mayindi insisted that his pension fund was unfairly kept by Old Mutual, Lombard said they did not have any of Mayindi's pension fund administered by Old Mutual. She said Mayindi's savings in the provident fund were already paid out to him.

In our previous article we also stated that Old Mutual reduced Kgamphe's premiums from R1600 to R484 without explanation, but Lombard insisted this was communicated to Kgamphe. Consumer Line asked her to supply proof of this but she had not done so at the time of publication.

Kgamphe suffered a pelvic bone fracture and a raptured bladder when he was involved in a motorbike accident in 2013. He is due for a fourth corrective operation and has early spinal arthritis that hinders his movement.

Kgamphe was covered for severe illness, including physical impairment, and premiums protection benefit, but he said Old Mutual rejected his claim on the grounds that he could still work.

Responding to Kgamphe's allegations that Old Mutual reneged on their undertaking to repay the premiums he paid while in hospital, Lombard denied that Old Mutual made this undertaking despite a written letter sent to Kgamphe signed by Lamees Isaacs of their claims department.

Lombard said Kgamphe only qualified for a benefit under the Premium Protection (Disability) benefits. She said Old Mutual has not reneged on refunding him his premiums as Kgamphe said.

Instead of refunding him his full premiums he paid while in hospital, Old Mutual paid them onto his new policy on his behalf, Lombard said. This could explain the reduced premiums.