Moreoever, every Insurer is in essence a gambler. When no claims are submitted or paid, all of the money they collect goes into their til or their coffers - all of it. Unfortunately when an insured party sustains a loss such as a disability, the plan has the obligation to pay the claim for the medical benefits; end of story.
In this as in all other instances, when the worker/employee uses his or her brain, seeks outside legal counsel and pursues their other legal remedies outside of Health Fund or fiduciary interests or concerns; when said worker/employee & their legal counsel prevail in their seperate legal action at law - the 'self insured, not for profit' Health Plan now seeks to engorge itself by taking for itself (and not the worker/employee) every cent it paid on the Medical/Disability claim thus zeroing out its obligation to pay anything as directly related to its obligation as the primary insurer.
Were the self insured plan here to prevail on this point of law - it would in fact remove itself from ERISA provisions & other government regulations and its corporate structure declaring itself a "non-profit" organization contrary to ERISA and the specific purpose of the Health Plan which is to fund & pay legitimate claims without trying to illegaly profit or by eating its young (plan participants).
Past that, Medical Benefits via non-profit, tax exempt self insured/funded plan participants are deferred compensation - period; part of wages. There is nothing to prevent unions or their members from ending self insured plans and via CBA's defunding these plans in whole and voting to put the hourly contribution directly into wages; or the weekly pay-check and perhpas given the vast corruption of funds nationwide, that is where the funding belongs - directly in the members hands.
Kinda ironic in that the member & his/her attorney do all the work, win the case, execute an agreement & then comes the fund with their hand out like a welfare recipient wanting a 41% cut of the plaintiff's proceeds ($121,500 of $300,000) for doing absolutley nothing.
The Sharks are reacting! The lawyers, many of whom are against the average worker/employee or their respective rights are crying foul. The correct response for any worker is simply this - spend the damn money & to hell with them. The Insurers & Re-Insurers profit off you year in, year out so who cares what they think or want.