Matthew Mazzola

Matthew P. Mazzola

Partner

Matthew P. Mazzola

Partner

  • Overview

    Biography

    Matthew Mazzola, a member of the firm’s Managed Care + Employee Benefit Litigation Group, focuses his practice in the areas of the Employee Retirement Income Security Act (ERISA) and managed care litigation; life, health, and disability benefit litigation; and related insurance coverage issues. He has spent much of his career litigating complicated life, health, and disability insurance related claims and disputes. Matthew creates a close working relationship with his clients to formulate an efficient legal strategy to meet their needs and effectuate a beneficial resolution.

    Health and Benefits Litigation

    Matthew defends life, health, disability and accidental death and dismemberment claims brought in state and federal court against insurers, plan administrators, employers, benefit plans, managed care organizations, preferred provider organizations (PPOs), health maintenance organizations (HMOs), third party administrators (TPAs), and pharmacy benefit managers (PBMs), including in cases governed by ERISA, Federal Employees Health Benefits Act (FEHBA), and the Federal Employees' Group Life Insurance (FEGLI) program. He has experience in many areas of life, health, and disability litigation, including complex health care issues involving ERISA, FEHBA and Medicare preemption, payor/provider contract disputes, nonparticipating provider reimbursement claims involving both federal and state law claims, pharmacy benefit plan/provider disputes, and behavioral health claim disputes, including claims alleging violations of federal and state Mental Health Parity and Addiction Equity laws. Matthew manages litigation from inception through trial/arbitration, tirelessly working to obtain the most beneficial resolution for his clients. He also has written many appellate briefs for clients in the United States Court of Appeals for the Second Circuit and the New York State Appellate Divisions involving complicated legal issues in both ERISA and non-ERISA cases.

    Insurance Coverage

    Matthew has experience advising professional service firms on insurance coverage issues related to professional liability insurance, employment practices liability insurance, management liability insurance, cyber insurance, and property and casualty insurance. He also has assisted professional service firms in resolving insurance coverage disputes with insurers. Matthew has negotiated, drafted and revised policy language, endorsements and warranties related to insurance coverage purchased by professional services firms and drafted complicated fee agreements and non-disclosure agreements to further business relationships.

    Insurance Litigation

    Matthew has experience defending insurers and private corporations in the areas of medical malpractice, premises liability, general negligence, property and casualty defense, and New York State Labor Law. He has achieved favorable results for these insurers and private corporations in both state and federal court. He also advises clients on complicated legal issues concerning the interpretation of contracts and insurance policies.

    Matthew regularly writes on ERISA matters for his clients and colleagues in the legal industry and has presented on these matters at conferences and continuing legal education programs.  

    Matthew has been selected as a Rising Star to the New York Metro Super Lawyers list from 2015 to 2019. While in law school, he was a member of the Pace University School of Law Moot Court and Trial Advocacy Teams and participated in several national competitions.

  • Experience
    • Experience

      Experience

      • Defended leading health insurer in a case involving plaintiff’s claim for benefits related to services provided by an air ambulance provider alleging the wrongful denial of benefits under an ERISA governed healthcare benefit plan. Obtained summary judgment dismissing the plaintiff’s complaint on the grounds that the health insurer’s denial of benefits was reasonably based on substantial evidence and not arbitrary and capricious because plaintiff’s claim for air ambulance transportation was not medically necessary as the services were requested solely for the convenience of the patient’s family.

      • Defended leading health insurer and self-funded health insurance plan in a case involving plaintiff healthcare provider’s claims alleging wrongful denial of benefits under an ERISA governed self-funded healthcare benefit plan. Obtained dismissal on the grounds that the plaintiff did not have standing to pursue its patient’s claim for healthcare benefits because the underlying ERISA plan included an anti-assignment clause voiding plaintiff’s assignment of benefits.

      • Defended leading health insurer in several different cases involving state law breach of contract, promissory estoppel, account stated and fraudulent inducement claims related to the health insurer approving the plaintiffs’ healthcare providers’ requests for pre-authorization. Obtained dismissals on the grounds that the plaintiffs’ state law claims were completely preempted by ERISA.

      • Defended leading health insurer in several cases involving plaintiffs’ (healthcare providers) claims alleging wrongful denial of benefits under ERISA governed healthcare benefit plans. Obtained dismissals on the grounds that plaintiffs did not have standing to pursue their patients’ claims for healthcare benefits because the underlying ERISA plans included anti-assignment clauses voiding plaintiffs’ assignments of benefits.

      • Defended leading disability insurer in a case involving a claim for ERISA disability benefits in which the plaintiff argued that, based on her diagnosis of multiple sclerosis, she was entitled to benefits. Obtained a favorable appellate ruling in the U.S. Court of Appeals for the Second Circuit reversing judgment for the plaintiff and entering judgment in favor of the defendant on the grounds that the District Court erred by finding that the defendant insurer/claim administrator acted arbitrarily and capriciously in denying plaintiff's claim for continuing disability benefits related to her multiple sclerosis diagnosis because her condition had improved and no longer met the ERISA's plan's definition of disabled. *

      • Obtained a summary judgment dismissing the plaintiffs' complaint in its entirety against defendant disability insurer, including the plaintiff plan participant's state law claims on the grounds that they were preempted by ERISA and her claim seeking an award of short-term disability benefits under an ERISA-regulated benefit plan on the grounds that the defendant insurer's adverse benefit determination was based on substantial evidence, and/or the lack thereof, and not arbitrary and capricious. In addition, obtained a summary judgment dismissing co-plaintiff's (i.e. the plan participant's relative) state law claims for breach of contract, negligent infliction of emotional distress, and intentional infliction of emotional distress related to the purported inadvertent release of her medical information on the grounds that the available evidence before the court did not satisfy the elements necessary to succeed on her state law causes of action. Obtained an affirmance in the Second Circuit of the district court's decision. *

      • Successfully represented leading health insurer at trial in New York City Civil Court in a case involving a claim for health benefits. Convinced trial court that plaintiff's complaint should be dismissed for failing to provide sufficient evidence to prove her claim. *

      • Defended insurer in mandatory arbitration in the U.S. District Court for the Eastern District of New York in a claim for accidental death and dismemberment benefits. Obtained a favorable ruling from the arbitrator, dismissing plaintiff's claim in its entirety after the arbitrator found that, based on the evidence and arguments presented, decedent's death was the result of a suicide and, therefore, not accidental. *

      * Atty. Mazzola was counsel in these representative matters before joining Robinson+Cole.

    • Honors + Awards

      Honors + Awards

      Selected as a Rising Star to the New York Metro Super Lawyers list from 2015 to 2019.

  • NEWS + PRESS
    • Publications

      Publications

      "Second Circuit," Chapter 2, ERISA Survey of Federal Circuits (2012, 2014, 2016, 2018, 2020 and 2022 Editions)

      "The Second Circuit’s Recent Decision on State Anti-Subrogation Laws Pokes a Hole in Otherwise Uniform Application of Federal Health Benefit Law," published in ABA's Health eSource (December 2014)

      "Recent Circuit Court Decisions May Limit Discovery in ERISA Health Benefit Litigation," published in ABA's Health eSource (February 2011)

    • Presentations

      Presentations

      "Litigation Update Regarding Health Insurance Claims for Emergency Service and the Effect of the No Surprises Act," (October 2021)

      "Sorry, I Spent It: Effect of Anti-Subrogation Laws for ERISA Plan Benefits," presented at the Eastern Claims Conference, New York, New York (March 2016)

      "Fraud Protection Privilege — Consider What You Write," (January 2016)

    • News

      R+C in the News

      • October 18, 2018

        51 Robinson+Cole Lawyers Recognized by Super Lawyers®

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      R+C News Releases

      • September 24, 2020

        Robinson+Cole Welcomes Matthew Mazzola as Partner in Managed Care + Employee Benefit Litigation Group

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      • December 17, 2018

        Robinson+Cole Promotes Nine Lawyers to Counsel

      • October 17, 2017

        Robinson+Cole Lawyers Recognized by Super Lawyers®

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        • View article