Partner Michail Hack
A public-sector financial services employee was covered by a long-term disability insurance plan through her employer. In 2021, the employee was rear-ended in a motor vehicle crash, which caused significant cervical and lumbar spine injuries and a partial rotator cuff tear. She experienced severe neck and back pain and numbness, tingling, weakness, and pain in the extremities. Her symptoms made prolonged sitting and standing difficult and interfered with basic activities such as writing, cooking, dressing, bathing, lifting, reaching, and walking, impairing her ability to perform her work and daily activities. The individual sought treatment from numerous specialists and underwent surgery, physical therapy, cervical epidural steroid injections, acupuncture, medications, and alternative treatments. Despite these interventions, she continued to experience pain and functional limitations, and her treating providers documented limited and painful spinal movement, muscle spasms, radicular symptoms, and difficulty maintaining seated or standing positions.
After initially approving long-term disability benefits, the plan administrator, Matrix Absence Management, Inc., later denied her claim, finding that she was no longer totally disabled under the plan’s definition. After she appealed and the insurer upheld its denial, she filed an action in 2025 against the plan and its administrator seeking reinstatement.
The Challenge
Schwartz, Conroy & Hack, PC Partner Michail Hack represented the client in the litigation, which was brought in the United States District Court for the Southern District of New York. Michail and his team faced daunting legal and procedural odds. The Court, the defendants, and the plaintiff all recognized that the plan was not governed by the Employee Retirement Income Security Act (ERISA), which generally applies to private-sector employer benefit plans. But the Court nonetheless applied a standard of review drawn from ERISA’s strict jurisprudence – the notoriously demanding “arbitrary and capricious” standard of review. This meant that Michail and his team were forced to litigate under some of the harshest conditions in American civil litigation, conditions that heavily favor insurance companies and plan administrators at every turn.
Under this framework, ERISA’s procedural restrictions stripped the plaintiff of tools that litigants in virtually every other area of civil law take for granted. There was no meaningful discovery. There were no depositions. No expert witnesses could be retained or presented to the Court. No jury of the plaintiff’s peers would hear her story. No trial. The case was decided entirely on a titular “administrative record” compiled by the very insurance company whose decision was being challenged – a record that, as the Court ultimately found, was itself incomplete and manipulated.
Under the “arbitrary and capricious” standard of review, a court will not second-guess an administrator’s decision simply because it disagrees with the outcome, or even because the evidence might support a different conclusion. As the Court itself noted, if a decision “is supported by a reasonable basis, the court may not substitute its judgment for that of the employer on disputed factual issues.”
In practice, this means that an insurer’s denial of benefits will be upheld so long as there is any reasonable basis for the decision – even if the claimant’s evidence is strong, even if treating physicians unanimously support disability, and even if a neutral observer might reach the opposite conclusion. Courts are expressly prohibited from reweighing the evidence or substituting their judgment for that of the plan administrator. The administrator is permitted to weigh competing evidence and resolve conflicts, and courts will generally defer to those determinations.
To overcome this standard, a claimant must demonstrate that the administrator’s decision was not merely wrong, but fundamentally unreasonable – that it lacked any rational basis, violated the plan’s own terms, or was the product of a process so flawed as to be indefensible. This is an extraordinarily difficult burden, and insurance companies routinely prevail under this standard even when the human equities strongly favor the claimant.
The Solution
Michail and his team undertook a meticulous, exhaustive review of a 2,600-page claim file densely packed with medical records, occupational analyses, physician narratives, imaging studies, treatment notes, and insurance company correspondence. Endless hours of careful analysis by the team exposed two fatal and independent defects in the denial that the Court found rendered the decision arbitrary and capricious.
Selective Compilation of the Medical Record
The team demonstrated that Matrix had arbitrarily cherry-picked which treating providers to contact for medical records, and then further arbitrarily limited its review to records generated after a cutoff date that corresponded to no meaningful clinical or administrative milestone, and which Matrix never explained. This arbitrary cutoff caused Matrix to ignore records from five of the plaintiff’s treating providers entirely, including her spine specialist – the very physician most relevant to her primary disabling condition of lumbar and cervical disc disease. The Court found this selective approach violated the plan’s own requirement that the administrator “take into account all available information” on appeal.
Michail and his team further exposed that Matrix’s own vendor had sent a cancellation notice to the plaintiff’s neurosurgeon, instructing him that his records were “no longer required” – effectively ensuring that critical records from her spine specialist never reached the decision-makers. Matrix attempted to dismiss this as a “misunderstanding” that “did not impact” its review. The Court was not persuaded.
Systematic Mischaracterization of the Evidence Reviewed
Even as to the records Matrix did review, the Schwartz, Conroy & Hack team demonstrated a pattern of selective quotation and misrepresentation that the Court found independently rendered the denial arbitrary and capricious. For example, Matrix claimed that a physical therapist’s records showed no limitations precluding sedentary work, citing findings of near-normal cervical range of motion and intact extremity strength. The team showed the Court that those same records contained the physical therapist’s explicit conclusion that the plaintiff “has difficulty in all activities of daily life” and “is totally disabled at this time” – a conclusion Matrix omitted entirely from its summary. This was only one of several misrepresentations highlighted by the team.
The Result
The Court denied the defendants’ motion for judgment on the administrative record and remanded the case to Matrix for full reconsideration, directing the administrator to resolve the procedural and substantive irregularities identified by the Court. The decision preserves the plaintiff’s claim and places the burden squarely back on Matrix to conduct the thorough, complete, and honest review it should have performed from the outset.
This remarkable outcome, achieved against daunting legal and procedural odds, reflects the Schwartz, Conroy & Hack team’s commitment to leaving no page unturned – no matter how voluminous, technical, or dense the record – in pursuit of justice for claimants whose disabilities have been unfairly minimized or ignored by insurance companies focused on their bottom line.
If your disability insurance claim has been denied or is being challenged, contact Schwartz, Conroy & Hack, PC. We have the expertise and tenacity to make insurance companies keep the promises they made to policyholders like you.