This section contains the nature of the case and procedural background.

On November 6, 2008, Charles, a trim carpenter, was severely injured in a motor vehicle accident during the course of his employment. His employer was Ryan Brown. Charles incurred fractures to the C3 and C4 vertebrae in his neck and disc herniations at the L4-5 and L5-S1 areas of his lower back. Dr. Jacob Schwarz, a neurosurgeon, performed an anterior cervical discectomy and surgical fusion of the C3 and C4 vertebrae on July 29, 2009, which improved the neck pain. After physical therapy and an epidural steroid injection, Charles still complained of severe back pain when bending forward or backward, pain that was more severe on his left side than on the right, and lower extremity pain. He also felt heaviness in his legs after walking for a short period of time such that he would have to sit down, which Dr. Schwarz opined was a symptom of neurogenic claudication. Dr. Schwarz recommended surgery on the L4-5 and L5-S1 areas of Charles' lower back. Granite (D), an insurance company, denied coverage for the surgery due to a peer review by three physicians disagreeing with Dr. Schwarz's findings. The insurance company also denied Dr. Schwarz's recommendation for epidural steroid injections. Dr. Schwarz then referred Charles to a pain management clinic and wrote a letter to D's insurance adjustor asserting that the pain was debilitating enough to prevent Charles from returning to work. Dr. William Leone, a pain management specialist. Dr. Leone was concerned with Charles's consumption of alcohol while taking his medication. Mr. Kilburn also admitted that because he felt the medication was no longer effective, he was taking two opioid tablets at once even though he had only been prescribed one tablet at a time. The urinary drug screen conducted showed the presence of both alcohol and opioid medication. As a result, Dr. Leone recommended weaning Charles off the opioid medication and trying other options. Dr. Leone prescribed 350 mg of Soma twice daily and 15 mg of oxycodone four times daily. Charles initialed and signed an agreement stating, 'I will control my usage of narcotic medications as directed by the attending physician. There are no exceptions. If medication is inadequate for [my] pain level, [I] must call before adjusting dosage.' On January 11, 2010, Dr. Tarek Elalayli recommended reducing the oxycodone dose and suggested that Charles return to work. Prior to the accident Charles was friendly and outgoing and was very active. After the injury and neck surgery he 'had anxiety about not having medication and not having the surgery' but Charles never appeared hopeless, just ready to be back to full capacity. Charles started skipping doses of his medication because he was scared that he was going to run out of the medication and would be unable to obtain more. P stated that after the accident, Charles 'felt worthless because he couldn't get out and earn a living and take care of his family' and he was 'still in a lot of pain,' 'seemed somewhat depressed,' and could only achieve intermittent sleep at night. P also claimed that the drinking was less than before the accident with occasional beers and maybe a six-pack sometimes on the weekends. P agreed that Charles had never been treated for anxiety or depression. Charles was found unresponsive in bed on the morning of January 28, 2010. The cause of death was acute oxycodone toxicity with contributory causes of hypertension, tobacco use, and alcohol use. His death was deemed an accident. Charles was forty years old at the time of his death. At trial, Dr. Finlayson opined that Charles was not suffering from true addiction but rather a dependency on the medication. He also opined that in a situation like Charles’ where there was potential for an interruption in his treatment, it was 'very possible' that the situation would cause a person anxiety. Dr. Hazlewood did not think that chronic pain such as Mr. Kilburn's could cloud a person's judgment. Dr. Hazlewood agreed that anxiety, depression, and suicidal ideations could cloud a person's judgment but stated that he was not qualified to state whether pain can cause an anxiety disorder. Both doctors agreed that the use of alcohol was the primary contributing factor to the death. The court agreed with P and awarded workers' compensation death benefits. D appealed.

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