Doctor sues insurers in benefits case

BANGOR – A local doctor has sued several insurers, charging they denied her benefits or granted very limited benefits when she became ill and filed disability claims under several insurance policies to which she had subscribed.

Dr. Vickie Sidou, an anesthesiologist, suffered neurological symptoms and heart palpitations that resulted in a reduced workload for her beginning in 1996. Her condition worsened in 1998 when she shifted to a part-time schedule, according to a civil lawsuit filed in mid-July at U.S. District Court in Bangor.

Because of a loss in income, Sidou applied for benefits from four disability policies she bought in 1985 from the New England Mutual Life Insurance Co., a subsidiary of New England Financial Co. of Massachusetts. The company since has merged with UnumProvident Corp., a Massachusetts firm and key defendant in the case.

The doctor also filed a claim under a group long-term disability policy offered by the Northeast Anesthesia Professional Association. The policy was managed by the Paul Revere Life Insurance Co., which also has merged with UnumProvident.

Sidou’s claims were denied as were all appeals that followed.

The lawsuit portrays a mountainous paper chase Sidou undertook, as she filed close to a dozen claims and appeals. The denials of claim came from policies Sidou took out as early as 1985 when she first came to greater Bangor. Sidou frequently works at the Eastern Maine Medical Center.

The lawsuit claims the insurers breached contracts by delaying payments or improperly imposing conditions of payment. All five policies eventually sought to have Sidou admit to a mental condition termed a general anxiety disorder.

The strategy may have been to limit the insurers’ payment responsibility to two years with a mental-condition clause, but the problem was the doctor wasn’t mentally ill, according to the lawsuit and her attorney.

“There is no basis” for the mental illness condition, said Attorney Frank T. McGuire of Bangor, who represents Sidou.

McGuire wanted the message conveyed to the public that Sidou is perfectly capable of performing her professional tasks.

“This is a partial disability. The problem doesn’t prevent her from working but requires her to be careful not to get overtired and she works a reduced schedule as a result,” said McGuire.

UnumProvident declined to comment. “It is our policy not to comment on pending litigation,” said Linnea Olsen, a UnumProvident spokesperson.

The lawsuit depicts Sidou as suffering financially from insurance company actions that are labeled as breaches of contract in the litigation. She seeks payment of full benefits from all policies without the “mental condition” stipulation, plus attorney’s fees and costs.

“Dr. Sidou has been damaged” by the alleged breaches and by a requirement that she acknowledge a non-existing mental condition in order to collect payment, according to the lawsuit.

Married, middle-aged and a mother, Sidou is portrayed in the lawsuit as a skilled anesthesiologist who began experiencing distressing physical symptoms in 1992. The symptoms included hypertension, palpitations, shortness of breath, lightheadedness and fast and irregular heartbeat, according to the lawsuit. She works for the Northeast Anesthesia Professional Association which became the Spectrum Medical Group in 1996.

In 1996, Sidou’s physical problems worsened, making it necessary for her to reduce her work schedule and on-call schedule, the lawsuit states.

In December 1996, she applied for benefits. A year later, the doctor filed appeals on all the benefit denials she had received and again was denied benefits. Sidou again requested reconsideration of the denial of benefits in July of 1998.

In August 1998, her medical condition worsened, according to the lawsuit. She was placed on medical leave in October, 1998, and remained out of work through February, 1999.

In December 1998, Sidou’s condition was diagnosed to be a disorder of the autonomic nervous system, the lawsuit states. Further specifics on her ailment were not disclosed.

The physician then submitted claims for total disability under the New England Life and Paul Revere policies. The Paul Revere firm, by then, had merged with UnumProvident and denied her claim. New England Life granted partial benefits under four policies. But, in a December 1999, letter, the company imposed a condition that ongoing treatment take place for a “supposed psychiatric condition of general anxiety disorder.”

New England Life granted benefits back to 1996 but imposed a two-year limit applicable to disabilities caused by a mental disorder.

UnumProvident reversed the decision on Jan. 7, 2000, stating Dr. Sidou’s disability was due to a pre-existing condition and demanded repayment of “overpaid” benefits of $58,845.50.

The doctor has appealed the repayment order. McGuire said both sides are in “constant contact.” If no settlement is reached, the case could be ready for trial within a year.