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3d Cir. – Interesting Remand to District Court

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  • 3d Cir. – Interesting Remand to District Court

    Here’s a new case out of the Third Circuit, unpublished, entitled Renee Killebrew v. The Prudential Insurance Company of America. In this matter, it appears as if the Third Circuit is making the arguments for the plaintiff. The court finds that the plaintiff raised issues on appeal, but only in a cursory manner without providing the Third Circuit appropriate explanation or argument. The court remands to District Court with three questions.

    In light of the genuine factual dispute over whether there is evidence to support limitations from Killebrew’s complaints of fatigue and pain, we vacate in part and remand to the District Court to determine three procedural factors: whether it was arbitrary and capricious for Prudential (1) to decide not to conduct an independent medical evaluation, (2) to rely on its medical experts’ conclusions that were contrary to Killebrew’s treating physicians’ opinions, and (3) to reject her complaints of fatigue and pain.
    The court finds this remand appropriate for the following reasons.

    The problem is that these findings are not supported by substantial evidence in the record. Id. Though Killebrew was not referred to pain management and was not prescribed narcotic pain medication, her medical records indicate she was prescribed a number of chronic pain medications, including Neurontin, Lyrica, and Cymbalta. J.A. at 1616–18; 1740. Given her multiple chronic pain medication prescriptions, a reasonable mind could not accept the absence of pain management and narcotic pain medication as adequate to support the conclusion there is “no evidence” to support limitations from Killebrew’s complaint of pain.

    We also cannot say the lack of clinical evidence adequately supports Prudential’s finding of “no evidence” to support limitations from Killebrew’s complaint of fatigue, given the undisputed subjective nature of fatigue and Prudential’s failure to explain to the Court what would constitute clinical evidence of it. Although Prudential contends there is no objective evidence of fatigue because Killebrew’s complaints of muscle spasms were not documented at any encounter and she was not being treated for spasticity, it does not explain that muscle spasms are objective evidence of fatigue, and it evaluated Killebrew’s complaint of spasms separately from her complaint of fatigue. J.A. at 1700, 2023. Because we decide not to afford deference to Prudential’s findings of “no evidence” to support any limitations from Killebrew’s complaints of pain and fatigue, we hold there is a genuine issue of material fact whether there is evidence of limitations from pain and fatigue.

    The District Court’s factual findings on whether there is evidence to support limitations from Killebrew’s complaints of fatigue and pain should inform its analysis of the three procedural factors we remand to the Court. Though it correctly held Prudential was not required by law to conduct an independent medical examination, and a number of multiple sclerosis symptoms are verifiable by objective tests, Prudential has not argued how Killebrew’s fatigue and pain may be established by objective testing. As such, its discretionary decision to forgo an independent medical evaluation may have been arbitrary and capricious if there is evidence to support limitations based on those complaints. The Court’s factual findings will similarly inform its decision on whether Prudential acted arbitrarily and capriciously by relying on its medical experts’ conclusions that conflicted with Killebrew’s treating physicians’ opinions and by rejecting her subjective complaints on the matter.
    The relatively short opinion is attached hereto.
    Attached Files
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