Judy Kilburn v. Granite State Insurance Company, 2017 Tenn. LEXIS 198

In 2008 Charles Kilburn, a trim carpenter, suffered cervical and lumbar spinal injuries in a work-related motor vehicle accident and later underwent cervical fusion. He continued to have severe lower back pain and was denied lumbar surgery by the carrier after peer review.
Kilburn was prescribed oxycodone and other medications; he was treated at a pain clinic and signed an agreement to follow narcotic dosing instructions. Medical records show he sometimes took more medication than prescribed and consumed alcohol while medicated.
On January 28, 2010, Kilburn was found dead; the medical examiner ruled death an accident due to acute oxycodone toxicity with contributory alcohol, hypertension, and tobacco use.
At trial, plaintiff (the widow) relied on a psychiatrist’s records review (Dr. Finlayson) to argue Kilburn’s pain, dependency, and possible withdrawal/anxiety—stemming from the compensable injury and denied surgery—impaired his judgment and made an inadvertent overdose likely.
Employer relied on a pain-management physician’s records review (Dr. Hazlewood) and on established precedent that an employee’s noncompliant medication use can be an intervening, nonindustrial cause.
The chancery court found the death compensable; the Tennessee Supreme Court reversed, holding Kilburn’s deviation from prescription/directions and alcohol use constituted an independent intervening cause that severed causal link to the workplace injury.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Kilburn’s overdose-death was a compensable consequence of his work injury or the result of an independent intervening cause	Kilburn’s pain, dependency, and anxiety from the work injury (and being denied surgery) impaired his faculties and made an inadvertent overdose a direct, natural result of the injury	Kilburn knowingly violated dosing instructions and consumed alcohol while medicated; that negligent, noncompliant conduct was an independent intervening cause that breaks the causal chain	Reversed trial court: death was not compensable because Kilburn’s noncompliant medication use and alcohol consumption were an independent intervening cause severing work-related causation

Simpson v. H.D. Lee Co., 793 S.W.2d 929 (Tenn. 1990) (medication taken contrary to instructions can be an intervening cause)
Anderson v. Westfield Grp., 259 S.W.3d 690 (Tenn. 2008) (progressive consequences of work injury are compensable unless produced by an independent intervening nonindustrial cause; negligence can constitute such an intervening cause)
Wheeler v. Glen Falls Ins. Co., 513 S.W.2d 179 (Tenn. 1974) (pre- Anderson-era case where aggravation of alcoholism after work injury was held compensable)
Jones v. Huey, 357 S.W.2d 47 (Tenn. 1962) (employee misconduct can relieve employer liability; court rejected requirement of only willful misconduct)
Guill v. Aetna Life & Cas. Co., 660 S.W.2d 42 (Tenn. 1983) (injecting medication contrary to medical instructions was an intervening cause)