## Facts

- Charles Kilburn, a trim carpenter employed by Ryan T. Brown, was seriously injured in a work-related motor vehicle accident on November 6, 2008.
- He suffered cervical fractures and lumbar disc herniations, leading to ongoing pain and treatment including cervical surgery in July 2009.
- Treating neurosurgeon Dr. Jacob Schwarz recommended lumbar surgery and additional injections due to persistent lower-back pain and symptoms consistent with neurogenic claudication.
- The workers’ compensation insurer denied coverage for the lumbar surgery and further injections after peer review physicians disagreed with Dr. Schwarz’s assessment.
- Dr. Schwarz referred Kilburn to pain management and indicated Kilburn’s pain prevented him from returning to work.
- In January 2010, pain-management specialist Dr. William Leone noted concerns that Kilburn consumed alcohol while taking opioids and sometimes took more than the prescribed dose; testing showed alcohol and opioids.
- Leone recommended tapering opioids and alternative treatments; evidence also showed Kilburn sometimes altered or skipped doses without medical direction.
- On January 28, 2010, Kilburn was found unresponsive; the medical examiner determined he died from an accidental oxycodone overdose with alcohol as a contributing cause.
- Kilburn’s widow sought workers’ compensation death benefits; the trial court found the death compensable as a direct and natural consequence of the work injury and its treatment.

## Issues

1. Whether the employee’s accidental oxycodone overdose, with contributory alcohol use, was a direct and natural consequence of the compensable work injury and its medical treatment.
2. Whether the employee’s noncompliance with medication instructions and alcohol use constituted an independent intervening cause breaking the chain of causation and barring death benefits.

## Decision

- The Tennessee Supreme Court reversed the trial court’s award of workers’ compensation death benefits.
- The court held the death was not compensable because the overdose resulted from the employee’s failure to take medication as instructed, which severed causation from the work injury.
- The court concluded the overdose, driven by noncompliant opioid use combined with alcohol, constituted an independent intervening cause.

## Legal Principles

- Employers remain liable for consequences that directly and naturally result from a compensable injury, including complications arising from reasonable medical treatment, unless a new independent cause breaks causation.
- An independent intervening cause may be found when an employee’s intentional or unreasonable conduct is the immediate cause of later injury or death and is not treated as a natural result of the original compensable injury.
- Medication-related complications may be compensable when the employee follows medical directions; deliberate deviation from dosing instructions and use of alcohol contrary to medical advice can constitute an independent intervening cause that defeats compensability.

## Conclusion

The court denied death benefits because the fatal overdose was legally attributed to the employee’s voluntary noncompliance with opioid directions and continued alcohol use, which broke the causal chain from the work-related injury under the independent intervening cause doctrine.


Kilburn v. Granite State Ins. Co., 522 S.W.3d 384 (Tenn. 2017)