J. Ascencio v. WCAB (PA DOC), 471 C.D. 2017

Background

Claimant (James Ascencio), a corrections officer, alleged he suffered an "injury to his heart" on July 3, 2010 while rescuing an inmate and sought benefits for a closed disability period from September 13, 2012 to March 25, 2013.
Employer (PA Dept. of Corrections) filed an untimely answer; WCJ initially granted the claim under Section 416 / Yellow Freight deemed-admissions doctrine, finding a cardiac injury and total disability for the claimed period.
WCJ acknowledged the petition lacked a defined cardiac pathology and expressed concern about ongoing-treatment scope; Board remanded, concluding "injury to the heart" was not well-pled and directing admission of additional evidence on causation.
On remand, Claimant submitted no new evidence; Employer produced a medical report but the WCJ discounted it; the WCJ and Board denied the claim for failure to meet the burden of proof and affirmed the remand order.
Claimant appealed, arguing the initial default judgment under Yellow Freight should be reinstated because the injury description was well-pled; the Commonwealth Court affirmed the Board, holding the allegation was not legally sufficient and causation required proof.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether an untimely answer bars Employer from contesting the legal sufficiency of the claim petition under Section 416/Yellow Freight	Ascencio: untimely answer = deemed admissions; "injury to the heart" is well-pled and Employer cannot rebut	Employer: legal sufficiency and causation are questions of law not waived by failure to answer; the petition is vague	Held: Employer's default does not admit legal questions (e.g., causation); untimely answer does not auto-satisfy claimant's burden
Whether the description "injury to the heart" is a well-pled, legally sufficient averment to support recovery for a remote, closed period of disability	Ascencio: the phrase plus factual context of exertion suffices under Yellow Freight / Hildebrand	Employer: the averment is vague, lacks pathology and does not show causal link to the 2012–2013 disability period	Held: Not well-pled here—vague description, >2-year gap to claimed disability, and absence of facts showing causation required expert proof
Whether claimant could rely solely on pleadings (no medical evidence) to prove causation for a non-obvious cardiac condition	Ascencio: pleadings and initial testimony suffice under cases allowing lay inference	Employer: causation for remote cardiac events is not within lay competence; requires medical proof	Held: Where causal link is not obvious, claimant must present medical evidence; pleadings alone insufficient
Whether the WCJ could consider Employer's medical report on remand despite initial default	Ascencio: Employer was barred from introducing rebuttal evidence by its late answer	Employer: remand allowed consideration of evidence because petition was not well-pled; late evidence admissible on remand	Held: Because the claim petition lacked well-pled allegations, consideration of competent evidence on causation was proper; WCJ gave that report no weight for independent reasons

Key Cases Cited

Yellow Freight Sys., Inc. v. Workmen’s Compensation Appeal Board, 423 A.2d 1125 (Pa. Cmwlth. 1981) (establishes that well-pled facts in a claim petition are deemed admitted when employer defaults)
Hildebrand v. Workmen’s Comp. Appeal Bd. (Fire Dep’t/City of Reading), 532 A.2d 1287 (Pa. Cmwlth. 1987) (claimant may sometimes rely on pleadings when facts allow lay inference of causation)
Greeley v. Workers’ Comp. Appeal Bd. (Matson Lumber Co.), 647 A.2d 683 (Pa. Cmwlth. 1994) (well-pled facts must be legally sufficient to support an award)
Bensing v. Workers’ Comp. Appeal Bd. (James D. Morrissey, Inc.), 830 A.2d 1075 (Pa. Cmwlth. 2003) (legal conclusions are not admitted by default)
D’Errico v. Workers’ Comp. Appeal Bd. (City of Phila.), 735 A.2d 161 (Pa. Cmwlth. 1999) (employer’s failure to answer does not waive questions of law)
Heraeus Electro Nite Co. v. Workmen’s Comp. Appeal Bd. (Ulrich), 697 A.2d 603 (Pa. Cmwlth. 1997) (en banc) (default is not equivalent to a judgment; employer barred from submitting rebuttal evidence only until answer deadline)
PIAD Precision Casting v. Workers’ Comp. Appeal Bd. (Bosco), 922 A.2d 967 (Pa. Cmwlth. 2006) (claimant retains burden to prove all elements despite employer’s untimely answer)
Neidlinger v. Workers’ Comp. Appeal Bd. (Quaker Alloy/CMI, Int’l), 798 A.2d 334 (Pa. Cmwlth. 2002) (causation is a legal element requiring adjudication)
Cardyn v. Workmen’s Comp. Appeal Bd. (Heppenstall), 534 A.2d 1389 (Pa. 1987) (unequivocal medical evidence may be required to establish causation for non-obvious injuries)
Tobias v. Workmen’s Comp. Appeal Bd. (Nature’s Way Nursery, Inc.), 595 A.2d 781 (Pa. Cmwlth. 1991) (laypersons cannot be expected to deduce causation for non-obvious medical conditions)