A. Ingrassia v. WCAB (Universal Health Services, Inc.)
126 A.3d 394
| Pa. Commw. Ct. | 2015Background
- Claimant (van driver) was rear‑ended on June 16, 2011; Employer issued a medical‑only Notice of Compensation Payable (NCP) for neck and lumbar strain/sprain and paid medicals only.
- Claimant stopped working the next day due to headache/dizziness and later developed left arm numbness; he filed a claim petition seeking disability benefits as of June 17, 2011.
- Medical evidence: Dr. Yang (claimant’s IME) diagnosed left ulnar neuropathy at the elbow and opined the injury was work‑related and disabling from the date of the accident; Dr. Katz (employer’s IME) found mild ulnar neuropathy but attributed it to nonwork causes and concluded no disabling injury.
- WCJ credited that claimant sustained left ulnar neuropathy and amended the NCP accordingly, but denied wage‑loss benefits, finding no credible medical proof of disability from the time of injury; WCJ accepted parts of claimant’s testimony but discounted Dr. Yang’s disability opinion as lacking a factual basis for dates before she saw claimant.
- The Board affirmed the denial of disability benefits; claimant appealed to this Court arguing the wrong burden was applied and that the WCJ capriciously disregarded uncontroverted medical evidence.
Issues
| Issue | Ingrassia's Argument | Universal Health Services' Argument | Held |
|---|---|---|---|
| Proper burden of proof after employer issued medical‑only NCP | Medical‑only NCP converts case to suspension/reinstatement; claimant’s credible testimony alone suffices to shift burden to employer to disprove work‑related disability | Because Employer accepted only non‑disabling injury, claimant must prove a disabling work injury in a claim petition by competent medical evidence | Court: WCJ and Board applied correct burden — claimant filed a claim petition and bore burden to prove disabling work injury by medical evidence |
| Sufficiency and weight of medical evidence tying ulnar neuropathy to disabling loss of earning power | Dr. Yang’s opinion (based on records and exam) ties ulnar neuropathy to accident and supports disability from date of injury | Dr. Katz attributed neuropathy to guitar/bicycling and said condition was not disabling/work‑related | Court: Dr. Yang’s opinion is competent; WCJ credited neuropathy diagnosis but failed to adequately explain rejection of Dr. Yang’s disability opinion and must make further findings on disability |
| Whether WCJ issued a reasoned decision addressing crucial conflicts | Credible testimony and Dr. Yang’s report were uncontroverted on disability and support an award for at least part of the period claimed | Employer pointed to claimant’s driving and guitar playing and Dr. Katz’s opinion to rebut disability | Court: WCJ’s decision was insufficiently reasoned regarding timing/extent of disability and capriciously discounted evidence; remand required for specific findings |
| Whether remand should permit new medical evidence or resolve on existing record | Requested reopening to allow treating‑physician records/testimony to correct WCJ’s adverse inference | Employer did not oppose remand on current record | Court: No need for additional evidence; remand directed for WCJ to decide based on the existing record with fuller findings and explanations |
Key Cases Cited
- Landmark Constructors, Inc. v. Workers’ Compensation Appeal Board (Costello), 747 A.2d 850 (Pa. 2000) (defines "disability" as loss of earning power)
- Dillon v. Workmen’s Compensation Appeal Board (Greenwich Collieries), 640 A.2d 386 (Pa. 1994) (workers’ compensation disability requires loss of earning power)
- Latta v. Workmen’s Compensation Appeal Board (Latrobe Die Casting Co.), 642 A.2d 1083 (Pa. 1994) (claimant’s credible testimony can satisfy reinstatement burden)
- Klarich v. Workers’ Compensation Appeal Board (RAC’s Association), 819 A.2d 626 (Pa. Cmwlth. 2003) (no suspension/reinstatement where no established loss of earning capacity)
- Mensah v. Workers’ Compensation Appeal Board (Norrell Temp Agency), 716 A.2d 707 (Pa. Cmwlth. 1998) (unequivocal medical evidence required when causal link between injury and disability is not obvious)
- Howze v. Workers’ Compensation Appeal Board (General Electric Company), 714 A.2d 1140 (Pa. Cmwlth. 1998) (suspension appropriate when injury no longer impairs earning power)
- Bufford v. Workers’ Compensation Appeal Board (North American Telecom), 2 A.3d 548 (Pa. 2010) (elements claimant must prove in reinstatement)
- Inglis House v. Workmen’s Compensation Appeal Board (Reedy), 634 A.2d 592 (Pa. 1993) (claim petition requires proof of all elements for award)
- Fotta v. Workmen’s Compensation Appeal Board (U.S. Steel/USX Corp. Maple Creek Mine), 626 A.2d 1144 (Pa. 1993) (claimant must prove work injury produced disability)
- Acme Markets, Inc. v. Workmen’s Compensation Appeal Board (Pilvalis), 597 A.2d 294 (Pa. Cmwlth. 1991) (WCJ may reject uncontroverted evidence only with a specific reasonable explanation)