ADJ3375264 · July 21, 2026

The WCJ initially held the issue of change of administration was barred by res judicata based on a 2014 order, but the WCAB found the 2014 order was not a final determination on the merits and thus did not bar reconsideration. However, the petition for change of administration was denied due to insufficient evidence of industrial causation.

From the decision · page 13Given that the issue of the right to a change in administration was decided by the WCJ during a status conference without creating a record, the issue was not actually litigated, and the decision was therefore not final and on the merits. As such, the necessary elements for collateral estoppel have not been met here. However, we do agree with the WCJ that CIGA’s petition for change of administration must fail as there is insufficient evidence of industrial causation to overlapping parts of body with respect to applicant’s other claims against Zurich and SCIF. Accordingly, we grant CIGA’s Petition for the sole purpose of amending the F&O to reflect that the issue of change of administration was not barred by res judicata or collateral estoppel. We otherwise affirm the F&O. For the foregoing reasons, IT IS ORDERED that CIGA’s Petition for Reconsideration of the April 24, 2026 Amended Findings and Orders issued by the workers’ compensation administrative law judge, is GRANTED. IT IS FURTHER ORDERED, as the Decision After Reconsideration of the Workers’ Compensation Appeals Board, that the April 24, 2026 Amended Findings and Orders issued by the workers’ compensation administrative law judge, is AFFIRMED, EXCEPT as AMENDED below.

The WCJ found no substantial medical evidence of injury AOE/COE to the neck and bilateral shoulders during the periods from March 12, 2000 through March 12, 2001 and from August 23, 2003 through August 23, 2004, based on medical reports that lacked sufficient reasoning or relied on inaccurate job histories.

From the decision · page 9evidence to support a denial of benefits. (citation.)” (Kyle v. Workers’ Comp. Appeals Bd (City and County of San Francisco) (1987) 195 Cal.App.3d 614, 621.) Here, in her Opinion on Decision (OOD), the WCJ provided the following explanation regarding her finding that there was no substantial medical evidence of injury AOE/COE to the neck and bilateral shoulders during the periods from March 12, 2000 through March 12, 2001 (ADJ4499046) and from August 23, 2003 through August 23, 2004 (ADJ3207121): Dr. Feiwell, at the request of CIGA, evaluates Applicant, over four years after the Order issued dismissing the original Petition for Change of Administration. In his report of December 12, 2018, he states “At this juncture, I can state that very little if any of complaints or findings are likely due to cumulative trauma and are due to the sequalae of the specific injury, his prior car accident and most significantly his cerebral palsy.” 21 He further states, “I cannot state with medical certainly that any of his increasing complaints of pain are due to anything other than his underlying cerebral palsy and the prior specific injury in 2003.” 22 He does request the complete medical file and treating physicians records, as well as a formal job analysis.

No substantial medical evidence supported injury AOE/COE to the neck and bilateral shoulders during the periods from March 12, 2000 through March 12, 2001 and from August 23, 2003 through August 23, 2004.

Favours Defendant prevailed

This lack of evidence led to denial of injury claims for those periods and rejection of change of administration petition.

From the decision · page 11Despite numerous reports solicited by the parties from a variety of medical legal evaluators, none are substantial medical evidence with regard to causation of the subsequent injuries, and the corresponding parts of body for each date of injury. CIGA has failed to establish injury arising out of employment and in the course of employment as to ADJ3207121 and ADJ4499046. CIGA has failed to prove that there was joint and several liability with SCIF and Zurich. Therefore, Defendants Zurich and SCIF are not available “other insurance” and therefore, does not remove applicant’s claim from the category of “covered claims” as provided in Insurance Code 1063.1.

The 2014 WCJ order denying CIGA’s Petition for Change of Administration was not a final determination on the merits and thus did not bar reconsideration by res judicata or collateral estoppel.

Favours Defendant prevailed

Allowed reconsideration of the change of administration issue, but petition was ultimately denied due to insufficient evidence of industrial causation.

From the decision · page 13Given that the issue of the right to a change in administration was decided by the WCJ during a status conference without creating a record, the issue was not actually litigated, and the decision was therefore not final and on the merits. As such, the necessary elements for collateral estoppel have not been met here. However, we do agree with the WCJ that CIGA’s petition for change of administration must fail as there is insufficient evidence of industrial causation to overlapping parts of body with respect to applicant’s other claims against Zurich and SCIF. Accordingly, we grant CIGA’s Petition for the sole purpose of amending the F&O to reflect that the issue of change of administration was not barred by res judicata or collateral estoppel. We otherwise affirm the F&O. For the foregoing reasons, IT IS ORDERED that CIGA’s Petition for Reconsideration of the April 24, 2026 Amended Findings and Orders issued by the workers’ compensation administrative law judge, is GRANTED. IT IS FURTHER ORDERED, as the Decision After Reconsideration of the Workers’ Compensation Appeals Board, that the April 24, 2026 Amended Findings and Orders issued by the workers’ compensation administrative law judge, is AFFIRMED, EXCEPT as AMENDED below.

Opined applicant sustained cumulative trauma work injury to cervical spine continuing through last day of employment; did not explain reasoning.

Opinion lacked explanation and was not substantial evidence.

From the decision · page 10CIGA also submits the medical legal reports of Dr. Steven Nagelberg. This doctor indicates that the applicant did sustain a cumulative trauma work injury to his cervical spine and that this continued through his last day of employment. He indicates there is one entire period of cumulative trauma and that each carrier is responsible, on a pro rata basis for the medical care and treatment as well as the temporary partial and temporary total disability. 25 Dr. Nagelberg fails to explain why he reaches this conclusion.

Found no reasonable medical probability of disability or impairment due to continual trauma through 2005; attributed disability to prior claims, degenerative process, and arthritis; did not explain reasoning.

Opinion lacked explanation and was not substantial evidence.

From the decision · page 10The medical legal report of Dr. Silver dated July 11, 2001, indicates there is a cumulative trauma to the hands and wrists (carpal tunnel), bilateral trigger thumbs. He also notes “Given the positive Adson testing, there is potential of contribution related to thoracic outlet syndrome.” He determines the causation was due to employment during SCIF’s CT period but fails to explain why he comes to this conclusion. He does not address the cervical spine. 26

Diagnosed cumulative trauma to hands and wrists (carpal tunnel, bilateral trigger thumbs) and potential thoracic outlet syndrome; did not explain causation reasoning and did not address cervical spine.

Opinion lacked explanation and was not substantial evidence.

From the decision · page 10The medical legal report of Dr. Silver dated July 11, 2001, indicates there is a cumulative trauma to the hands and wrists (carpal tunnel), bilateral trigger thumbs. He also notes “Given the positive Adson testing, there is potential of contribution related to thoracic outlet syndrome.” He determines the causation was due to employment during SCIF’s CT period but fails to explain why he comes to this conclusion. He does not address the cervical spine. 26

Diagnosed status post anterior cervical fusion with ongoing left upper extremity symptoms and history of bilateral carpal tunnel; concluded condition caused by continuous trauma rather than specific injury; supported denial of injury AOE/COE during 2000-2001 period.

Supported denial of injury AOE/COE for 2000-2001 period.

From the decision · page 3bilateral hands and wrists. (Exhibit A12, pp. 4-5.) The claim was accepted by SCIF but closed due to inactivity. (Exhibits B6 and B9). On or about August 1, 2005, applicant filed an Application for Adjudication of Claim (Application) against Healthcare Partners and SCIF, alleging that he sustained an injury AOEC/COE during the period from January 2, 1991 through March 12, 2001 (ADJ4499046) to the bilateral upper extremities. (Exhibit B10.) On October 24, 2005, Israel Rottermann, M.D. evaluated applicant and diagnosed him with “status post anterior cervical fusion with ongoing left upper extremity symptoms” and “history of bilateral carpal tunnel[.]” (Exhibit A4, p. 8.) Dr. Rottermann concluded that applicant’s condition was “caused by a continuous trauma rather than a specific injury.” (Ibid.) SCIF denied applicant’s claim On October 27, 2005, and advised that their denial was based upon the opinions of Dr. Rottermann who found that applicant did not sustain injury AOE/COE during the period from March 12, 2000 through March 12, 2001.

Found very little if any complaints or findings likely due to cumulative trauma; attributed most findings to prior specific injury, prior car accident, and cerebral palsy; noted lack of formal job analysis and unclear job history.

Relied on incomplete and unclear job history, and found complaints likely due to non-industrial causes.

From the decision · page 9evidence to support a denial of benefits. (citation.)” (Kyle v. Workers’ Comp. Appeals Bd (City and County of San Francisco) (1987) 195 Cal.App.3d 614, 621.) Here, in her Opinion on Decision (OOD), the WCJ provided the following explanation regarding her finding that there was no substantial medical evidence of injury AOE/COE to the neck and bilateral shoulders during the periods from March 12, 2000 through March 12, 2001 (ADJ4499046) and from August 23, 2003 through August 23, 2004 (ADJ3207121): Dr. Feiwell, at the request of CIGA, evaluates Applicant, over four years after the Order issued dismissing the original Petition for Change of Administration. In his report of December 12, 2018, he states “At this juncture, I can state that very little if any of complaints or findings are likely due to cumulative trauma and are due to the sequalae of the specific injury, his prior car accident and most significantly his cerebral palsy.” 21 He further states, “I cannot state with medical certainly that any of his increasing complaints of pain are due to anything other than his underlying cerebral palsy and the prior specific injury in 2003.” 22 He does request the complete medical file and treating physicians records, as well as a formal job analysis.

Braewood Convalescent Hospital v. Workers’ Comp. Appeals Bd. (Bolton) (1983) Cal.3d 159, 164

Substantial medical evidence requires relevant, credible, and reasoned medical opinions based on accurate facts.

Applied to evaluate medical opinions on injury AOE/COE during disputed periods.

From the decision · page 816.) As the parties are well aware, substantial medical evidence is used to establish industrial causation. “The term ‘substantial evidence’ means evidence which, if true, has probative force on the issues. It is more than a mere scintilla, and means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion…It must be reasonable in nature, credible, and of solid value.” (Braewood Convalescent Hospital v. Workers’ Comp. Appeals Bd. (Bolton) (1983) Cal.3d 159, 164 [48 Cal.Comp.Cases 566], emphasis removed and citations omitted.) Pursuant to E.L. Yeager v. Workers’ Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th922, 928 [71 Cal.Comp.Cases 1687], “[a] medical opinion is not substantial evidence if it is based on facts no longer germane, on inadequate medical histories or examinations, on incorrect legal theories, or on surmise, speculation, conjecture, or guess. (citations.) Further, a medical report is not substantial evidence unless it sets forth the reasoning behind the physician's opinion, not merely his or her conclusions. (citation.)” “A medical report which lacks a relevant factual basis cannot rise to a higher level than its own inadequate premises. Such reports do not constitute substantial

E.L. Yeager v. Workers’ Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th922, 928

A medical opinion is not substantial evidence if based on inadequate medical histories, incorrect legal theories, or speculation.

Applied to reject medical opinions lacking factual basis or reasoning.

From the decision · page 816.) As the parties are well aware, substantial medical evidence is used to establish industrial causation. “The term ‘substantial evidence’ means evidence which, if true, has probative force on the issues. It is more than a mere scintilla, and means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion…It must be reasonable in nature, credible, and of solid value.” (Braewood Convalescent Hospital v. Workers’ Comp. Appeals Bd. (Bolton) (1983) Cal.3d 159, 164 [48 Cal.Comp.Cases 566], emphasis removed and citations omitted.) Pursuant to E.L. Yeager v. Workers’ Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th922, 928 [71 Cal.Comp.Cases 1687], “[a] medical opinion is not substantial evidence if it is based on facts no longer germane, on inadequate medical histories or examinations, on incorrect legal theories, or on surmise, speculation, conjecture, or guess. (citations.) Further, a medical report is not substantial evidence unless it sets forth the reasoning behind the physician's opinion, not merely his or her conclusions. (citation.)” “A medical report which lacks a relevant factual basis cannot rise to a higher level than its own inadequate premises. Such reports do not constitute substantial

Dr. Feiwell's medical reports relied on an inaccurate or unclear history of applicant's job activities, undermining their evidentiary value.

From the decision · page 9There was no “formal job analysis” provided to Dr. Feiwell. Applicant did not provide testimony at trial to clarify what his job duties were as a medical records clerk, and if these duties changed over the course of his employment. CIGA relies on a variety of sources describing the applicant's job duties, from the reporting of Nagelberg, to the Applicant’s deposition testimony and mere speculation. Dr. Feiwell specifically states, when referring to the weightlifting requirements of the job, that he does not “even know if it’s accurate. I assume that some of it was, which was why I apportioned according to pathology versus what he said he was doing.” 24 The medical reports of Dr. Feiwell are not substantial medical evidence since he relied on an inaccurate, or at least unclear, history of the applicant's job activities.

Dr. Nagelberg's opinion lacked explanation for his conclusion of cumulative trauma injury continuing through last day of employment.

From the decision · page 10CIGA also submits the medical legal reports of Dr. Steven Nagelberg. This doctor indicates that the applicant did sustain a cumulative trauma work injury to his cervical spine and that this continued through his last day of employment. He indicates there is one entire period of cumulative trauma and that each carrier is responsible, on a pro rata basis for the medical care and treatment as well as the temporary partial and temporary total disability. 25 Dr. Nagelberg fails to explain why he reaches this conclusion.

Dr. Silver's report indicated cumulative trauma to hands and wrists but failed to explain causation and did not address cervical spine.

From the decision · page 10The medical legal report of Dr. Silver dated July 11, 2001, indicates there is a cumulative trauma to the hands and wrists (carpal tunnel), bilateral trigger thumbs. He also notes “Given the positive Adson testing, there is potential of contribution related to thoracic outlet syndrome.” He determines the causation was due to employment during SCIF’s CT period but fails to explain why he comes to this conclusion. He does not address the cervical spine. 26

Dr. Sanders found no reasonable medical probability of disability due to continual trauma and attributed disability to prior claims and degenerative conditions, but did not explain reasoning.

From the decision · page 10On November 12, 2008, Dr. Sanders issues a medical legal report at the request of Zurich. He states, “this does not appear to be reasonable or appropriate and is not based upon reasonable medical probability that any of his disability or impairment would be apportioned to his continual trauma through 2005.” 28 He does not explain the reasoning for his opinion, and states “This patient has had all the same diagnoses, problems, and limitations which pre-existed his last continual trauma period. It is demonstrated by the records noting such findings. With regard to the patient’s hands and shoulders, his disability would be related to his prior claims, cases, injuries, degenerative process, and arthritis existing up to and through 2002, when he settled his last claim. There is no additional continual trauma. He simply has had exacerbations, but not aggravations. Therefore, 1 [sic] would indicate that his continued work until 2005 did nothing but cause exacerbation, at which point