Do Long-Term Disability Policies Provide the Protection They Promise? (111th Congress Senate Hearing)

The cliff notes version of my ERISA umbrellaed long term disability insurance policy experience is that I was a successful professional employee with a large healthcare system when I became ill to the point of no longer being able to perform my job duties.  I believed that my financial future was protected by my long term disability insurance policy coverage in the event of a major health crisis that prevented me from remaining in my employment position.  I received short term benefits for six months and long term benefits for approximately seven months after short term benefits transitioned into long term coverage.  And then unexpectantly (with no change in health condition, diagnosis or prognosis), I was abruptly denied benfits. I appealed the denial, lost the appeal and I am now in the process of seeking relief in the only manner available to me at this point in time – a federal lawsuit under 502(a) of ERISA law.  I no longer believe that long-term disability policies provide the protection that they promise.

Recently, when researching my own case, I came across a transcript and video of a United States Senate Finance Committee hearing which took place on September 28, 2010 that fully addresses the heart of the problems that I have been grappling with for the past two years.  (See Do Private Long-Term Disability Policies Provide the Protection They Promise?) on the United States Senate website.  I was shocked to see that even the United States Senate recognizes that the system is broken, is unfairly baised against the claimant in favor of the insurance companies and in dire need of reform.  From the opening statement of Hon. Max Baucus, A U.S. Senator from Montana, Chairman, Committee on Finance:


“Thousands of cases clog the district courts. Many claimants end up in desperate straits. Some lose their homes, their savings, and even their spouses or custody
of their children.  How do the insurance companies get away with these abuses?
Unfortunately, loopholes in the law permit them.

First, ERISA preempts State insurance measures to address
these abuses. That means that claimants cannot get jury trials,
pretrial discovery, or the right to submit evidence to the court. And
claimants cannot receive punitive or consequential damages.

Second, companies can include what is called a discretionary
clause in their insurance plan document. In most States, these
clauses mean that it is not enough for a claimant to prove that the
company’s reasoning is weak when it decides to deny benefits. To
win the case, the claimant has to prove that the company’s reasoning
is arbitrary or capricious. That is a significantly higher

It is time to close these loopholes. It is time to end the abuses.
An insurance policy is only good if the insurance company actually
compensates the consumer when there is a loss, and insurance law
is only good if it helps to make that happen. It is time to make sure
that the law does that.

So let us hear what is happening in the long-term disability insurance
industry. Let us hear what we might do to fix it, and let us do what we can to make sure that insurance is good for the consumer
when there is a loss.”

And yet, almost five years past the date of this hearing, nothing has changed.  The system is still broken, unfairly biased against the claimant in favor of the insurance companies and in dire need of reform.  From testimony presented by Mark D. DeBofsky. Attorney at Law Adjunct Professor of Law – John Marshall Law School:

“The ways in which ERISA can be amended to bring about these changes are not unduly complex. One possibility would be to amend the definition of “welfare benefits” in ERISA to clarify that the purchase of insurance as a means of funding employersponsored disability, health, or life insurance benefits excludes the resulting plan from ERISA altogether, leaving claimants with the existing protections of already wellestablished state laws, rights, and remedies. Another proposal would be to amend § 502 of ERISA to provide that claims brought under insured plans will always be adjudicated in accordance with the same plenary standards and proceedings afforded any other civil action brought in federal court. Finally, the language in § 502(a)(3)(B) which currently permits plan participants to seek appropriate equitable relief has led to a judicial interpretation that too often results in there being no relief whatsoever available to claimants such as those aggrieved by misrepresentations or omissions by employers. Simplifying the statutory language to enable recovery of relief at large would remedy a great unfairness that currently exists. These proposed changes would restore the intent and purpose of the comprehensive benefits reform enacted by Congress more than thirtyfive years ago. More importantly, such changes can help rebuild public confidence in insurance companies that have, for too long, been able to hide behind legislative shields and judicial protections that no other industry receives.”

In response to this, I have started an online petition:  Long Term Disability Insurance Policy Reform – Equal Rights for ERISA Long Term Disability Insurance Policy Holders.




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Patient Story for Rare Disease Awareness Day…Video to Follow

My name is Darlene Ulmet.  I live on the Outer Banks of coastal North Carolina and I am a rare disease patient. Before I share my patient story I would like to first clarify the definition of a rare disease.


There is no single, widely accepted definition for rare diseases.

Some definitions rely solely on the number of people living with a disease, and other definitions include other factors, such as the existence of adequate treatments or the severity of the disease.


Quoting from Wikipedia: In the United States, the Rare Diseases Act of 2002 defines rare disease as “any disease or condition that affects less than 200,000 people in the United States,” or about 1 in 1,500 people.

In Japan, the legal definition of a rare disease is one that affects fewer than 50,000 patients in Japan, or about 1 in 2,500 people.

The European Commission on Public Health defines rare diseases as “life-threatening or chronically debilitating diseases which are of such low prevalence that special combined efforts are needed to address them.” The term low prevalence is later defined as generally meaning fewer than 1 in 2,000 people. Diseases that are statistically rare, but not also life-threatening, chronically debilitating, or inadequately treated, are excluded from their definition.

The definitions used in the medical literature and by national health plans are similarly divided, with definitions ranging from 1/1,000 to 1/200,000.

Confusing?  Yes, it is.

And that is why I chose to begin this patient story with the general definition of a rare disease. It is very illustrative of the typical total experience of being a rare disease patient seeking a medical diagnosis and a treatment plan. The information obtained from various sources is often varied and conflicting and it is maddening to try to ascertain the truth of the matter regarding your medical condition and prognosis. There are over seven thousand rare diseases that affect over fifty million people worldwide and I am only one among many.

I first became a rare disease patient at age four years of age when I was hospitalized for fever, swelling and uncontrolled bleeding under the skin.  I was diagnosed as having Immune thrombocytopenia.   Immune thrombocytopenia, also known as immune or idiopathic thrombocytopenic purpura and often referred to as ITP, is a rare bleeding disorder characterized by a low amount of platelets in the blood. Platelets are needed for clotting of the blood. In patients with ITP, a person’s own immune system creates antibodies that mark healthy platelets as “foreign substances” and then mistakenly attack and destroy them. As an autoimmune disease that results in the destruction of platelets, patients with ITP have a tendency to bleed or bruise. I was successfully treated and then released from the hospital but this would not be the end of my experience as a rare disease patient.

I grew up normally, attended college, received a degree in a technical discipline, married and had children – five of them!  Throughout my life, I experienced brief episodes of both pain and fatigue but I did not, at the time, give much thought to the significance of these events as I was progressing through the stages of life successfully. Because the symptoms would often disappear as quickly as they had mysteriously appeared and they caused only minor nuisance interruptions in my life, I did not further pursue any medical investigation but looking back, it is now obvious that I never fully escaped the grip of autoimmune disease attack.

Just as my children reached adulthood and began to leave the nest and my career was reaching its full potential, I began to experience an alarming number of symptoms that caused me grave concern.  My lower legs began to discolor in a motley rust colored lace-like pattern.  It started at my toes, progressed to cover the entire area which would normally be hidden by an athletic crew sock, and began to spread up my legs eventually stopping, over the course of several years, at just below the knees.  I began to experience seemingly random intense pains all over my body and they were of such intensity that normal daily living activities became interrupted.  But far worse than the physical manifestations and the associated (I have now learned) pain, were the episodes of extreme fatigue that I experienced.

I recall two events that raised sufficient concern for me to launch a full blown medical investigation.  The first event occurred at the University of North Texas in Denton, Texas where I was attending my youngest son’s freshman orientation program.  The second event occurred in downtown Dallas, Texas on the return commute home from work.  On both occasions, I became so physically exhausted that I could not travel further.  At UNT, I missed the luncheon that I had been very much looking forward to attending with my children and in downtown Dallas, I became so weak that I had to sit on the sidewalk leaned against a brick wall (no doubt covered in urine, spit and other bodily fluids) while waiting for the next Dart Rail train.

Thus I began my medical investigation by scheduling an appointment with my primary care physician, Dr. Charles Cook at Bedford Family Medicine in Hurst, Texas.  Dr. Cook gave me several referrals including: a cardiologist (to rule out heart disease as the source of fatigue),  a sleep study (to rule out sleep apnea and related sleep dysfunctions as the source of fatigue), a neurologist (to rule out several possible neurologic diseases such as Muscular Dystrophy) and a dermatologist (to examine the abnormal skin condition).  He also ordered blood work to be performed.  But the greatest of all the things that Dr. Cook did for me was to acknowledge the limitations in modern medicine in many circumstances.  He introduced me to the frightening world of “there is no cure” and “rare disease” with an honesty and truthfulness for which I will be forever grateful.

I continued to investigate my health condition over the course of several years seeking treatment near and far from home eventually landing at John Hopkins Medical University in Baltimore, Maryland.  I recall the day exact day when one of my physicians (I have since come to refer to my medical team as my group of “ologist”) made the final connection that led to the identification of my one of my rare diseases – Cryoglobulinemia.  I was describing several examples of recent fatigue incidents and I casually mentioned that “I often can barely make it to work in the morning.  Getting dressed alone is exhausting and I find it difficult to get through my morning routine in a timely manner. I used to take the early train and now I can barely make the mid-morning departure.  Once at work, I sometimes have difficulty performing tasks that once were very easy for me to execute.  And after work, I sometimes feel fantastic!”

Much to her credit, Dr. Costner (a dermapathologist) keyed in on the timing and weather factor and ordered tests for Cryoglobulinemia- a very rare blood disease in which blood proteins thicken as precipitates when the patient is exposed to cold temperatures.  She correctly connected the dots regarding temperature and weather in that when I went to work in the morning, I was often exposed to cold weather conditions and at work the air conditioning was blaring but in the afternoon, especially in Texas, the environment had warmed up sufficiently to allow my system to operate more efficiently. She, unlike many physicians, had the insight to look for the “zebra among the horses.”  If you are not familiar with that phrase, it is really a quite interesting analogy to rare disease patients. “Zebra is the American medical slang for arriving at an exotic medical diagnosis when a more commonplace explanation is more likely. It is shorthand for the aphorism coined in the late 1940s by Dr. Theodore Woodward, professor at the University of Maryland School of Medicine, who instructed his medical interns: “When you hear hoofbeats, think of horses not zebras”. Since horses are common in Maryland while zebras are relatively rare, logically one could confidently guess that an animal making hoofbeats is probably a horse. By 1960, the aphorism was widely known in medical circles.”

What is it like to be a patient with a rare disease?  To put it bluntly, it is living hell.  The damage Cryoglobulinemia inflicts on me is not limited to my physical body alone.  It affects my mental faculties through decreased concentration abilities and cognitive functioning skills. It has robbed me of a rewarding career.  It bleeds over into many other areas of my life also, destroying anything and everything in its path – finances, relationships, and psychological health.  Both self-sufficiency and self-esteem are annihilated as one becomes more and more dependent on family, friends and society at large. Private insurance companies long-term disability coverage and governmental Social Security Disability Insurance program payments take years to obtain and are frequently terminated sporadically for months at a time leaving me and other patients like me in further medical and financial distress.

I fight the good fight every single day of my life.  I fight for maintaining the best possible health outcome possible with a disease that can turn as angry as the Atlantic Ocean in a nor’easter and wipe me out just as swiftly as the sea takes down an old wooden pier.  I fight for funds to keep me from going hungry and homeless – a constant fear that is very threatening and real during times of substantial loss of income.  I fight for medical treatment access and expensive medications that will keep my disease from progressing into organ involvement that could prematurely end my life in a very short period of time. I fight for rare disease patients of ANY kind as a patient advocate for rare disease individuals, perhaps selfishly,  in an effort to take the  focus off myself and identify ONE single reason for living through many difficult painful and exhausting days.  I fight for “others” because I am often far beyond having the required energy to fight solely for myself.

I am so very thankful for the Alliance for Cryoglobulinemia, for they have not only provided very important medical information necessary for keeping me as healthy as possible with a rare disease but they have also warmed my heart by reminding me that “I am RARE but NOT alone.”

And I am also very much thankful for each and every day that I can remain on the Outer Banks of North Carolina which is and always has been “my happy place.”  In many ways, living on this wonderful sandbar is all that I have left in my happiness tank.  I hope and pray that I will be here for many years to come.

Take care, thank you for reading this post through to the end and learning more about what is like to be a rare disease patient, and God Bless!

You are invited to attend, Raise and Join Hands OBX! – a National Organization for Rare Disease awareness event sponsored by the Alliance for Cryoglobulinemia on Saturday, February 28, 2015 on the front lawn at OBX MD, Milepost 2.5. 4721 North Croatan Highway, Kitty Hawk, NC.  I will be presenting the North Carolina Governor’s Proclamation of Rare Disease Day at this awareness event. I hope to see you there!

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More Rare Disease Awareness 2015 Activities



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Finished the slide video for the Alliance for Croglobulinemia in recognition of Rare Disease Day, February 28, 2014.  Working on the patient interview story and the reception at OBX MD at the end of the month.  Please share liberally!


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Spring 2015

I am settling in to my new life on the Outer Banks of North Carolina and I am very happy with my decision to relocate here from Texas.  Who says you can’t go home?  I have a number of projects – some personal and some professional – in the works as I transition from traditional employment to contract work in order to adapt to living life with autoimmune diseases.

RDD-2015-FBbadgeA primary focus for me in February will be working with the Alliance for Cryoglobulinemia and doing what I can to support Rare Disease Day 2015.  I am working on two very personal patient videos for the Alliance for Cryo that I will showcase here when completed.  As with many autoimmune diseases, I have good days and bad days.  All we can do is to make the best of each day we are given and do what we can to privide a better future for the next generation.

MysteryShopperI have also been heavily involved in Mystery Shopping and Retail Store Audits.  The pay is lousy but the flexibility of being able to accept assignments according to my health condition on any given day is working out very well and I am enjoying the reimbursable freebie purchases immensely.   This has also gotten me out of the house and into the community which has been of great benefit in preventing me from becoming a total recluse during these cold and windy off-off-season not so beach-like weather months.

DCAC-imageAdditionally,  I have very much enjoyed attending the Dare County Arts Council Open Mic Literary Workshops where I have met some amazing local writing talent.  Being a member of this group has also forced me to complete writing projects and to resurrect some long abandoned works.  I am looking forward to becoming a true Outer Banks author…three full decades from when I first established this dream.

In other news, I have volunteered again!  Long before I returned home to the Outer Banks, I developed an acute interest in both N.E.S.T (Network for Endangered Sea Turtles) and Marine Mammal Stranding Network.  I have my first volunteer orientation training coming up in early February and I look forward to sharing some amazing videos, stories, and photos in the upcoming months.  Living on the coast has inspired me to take action to protect those things that have endeared the coastal living experience to me and I am proud to serve in this capacity.  Please enjoy the video below!

geocacheDue to the extreme weather and my health conditions I have not yet been able to pursue very much geocaching activity but I look forward to getting back into “geeks with GPS treasure hunting” once the weather improves.  I have already scouted out a number of caches that I am anxious to visit. My trackable was hijacked and stalled out 16 miles from where it began in Virginia on what was to have been a cross country trip to Texas to visit my children.  I have learned a bit about trackables since and I will be sending another one out into the world this spring and hopefully it will have a better demise.

For many reasons, this has been a very difficult relocation and there have been many obstacles along the way but I am slowly pulling it all together.  I am very much looking forward to the many new and wonderful experiences that living life on the Outer Banks will provide.  I have had many friends and family inquire as to how and why this relocation came about and I am sometimes at a loss on how to explain it but there is a country music artist whom I greatly admire and respect who captures it very well.  Kenny Chesney, I ain’t ever going back again either!

I ain’t ever going back again
I’m happy in the place I’m in
Surrounded by my best friends, that I just met today

A toast to Sara and a toast to Sam
Here’s to jammin’ to this three quarter jam
Let the world go on, I don’t give a damn
I ain’t ever going back again

I’m gonna stay down here for the whole season
And when the season’s done, I still ain’t leavin’
‘Cause lately I’ve given up on making sense
Out of life and love so I’m gonna stay
Like The Band, I’m gonna drift away

I ain’t ever going back again
I’m feelin’ comfortable in my skin
A little numb but I’m on the mend
Yeah, I think I’m gonna be okay

A toast to Sheila and a toast to Jane
I may never know their last names
It don’t matter in the shape we’re in
I ain’t ever going back again

I’m gonna stay down here for the whole season
And when the season’s done, I still ain’t leavin’
‘Cause lately I’ve given up on making sense
Out of life and love so I’m gonna stay
Like The Band, I’m gonna drift away



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Fall 2014


Well, I am finally “home” and settling in for the winter on the Outer Banks.  I have several writing projects going as well as some part-time project work opportunities of a light technical nature.  I have found a potential new church home –  I have never been a Baptist before but I hear they are heavily casserole ladden – so I am sure we will get along just fine.  The doctrine aligns with my religious beliefs and the church had a comfy cozy feel.  I still have a few other congregations I would like to visit before making a final decision.

I can’t get enough of the sunrises and sunsets nor the shrimp, crab and Carolina BBQ not to mention the Collard Greens.  The photo below was last night’s beautiful moon over the Atlantic.  Good night moon!


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Spring 2014

My biggest news for Spring 2014 is that I have “semi-retired” and I am now homeward bound from Texas to the East Coast, specifically to the Outer Banks of North Carolina. Jacques Yves Cousteau said it best:

Cousteau Quote


I left Texas on March 19th, 2014.  Thus far, I have spent three glorious weeks at the beach (in Kitty Hawk, NC) and several weeks in the country further up the coastline.  I have visited about half of the places and people that I wished to reconnect with before settling in on the OBX.  It has been quite an adventure.  More details and photos to follow!

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