In 2008, Charles Kilburn suffered spinal injuries in a car accident that occurred in the course of his employment. He had surgery for neck pain in July of 2009, but he continued to suffer back pain and neurological issues. Kilburn’s doctor recommended back surgery, but Kilburn’s insurance company would not cover the procedure. On January 4, 2010, a pain-management specialist evaluated Kilburn. The specialist’s notes expressed concern that Kilburn was drinking alcohol while taking medication and that Kilburn was taking greater doses of opioids than prescribed because he felt the medication was no longer working. The specialist prescribed a muscle relaxant and oxycodone and made Kilburn promise to speak to a physician before adjusting his dosage. Kilburn developed anxiety about not having the back surgery and not having medication. He started skipping doses of his medicine because he was worried that he would run out and not be able to get more. On January 28, 2010, Kilburn’s wife, Judy (plaintiff), found Kilburn unresponsive in bed. The medical examiner deemed Kilburn’s death an accidental oxycodone overdose with contributory causes including alcohol use. Judy brought an action against Kilburn’s employer and Granite State Insurance Company (defendants), seeking workers’-compensation death benefits. At trial, Judy presented testimony from a psychiatrist who specialized in addiction. He testified that it was more likely than not that Kilburn was suffering from severe pain and anxiety at the time of his death and that those conditions possibly could have made Kilburn more susceptible to overdosing. He also testified that the medications Kilburn was taking could have made Kilburn feel hopeless and clouded his judgment. Kilburn’s employer presented testimony from a pain-management specialist who said that chronic pain could not cloud someone’s judgment. He also testified that he was not qualified to opine on whether pain could cause an anxiety disorder. The trial court credited Judy’s addiction-specialist’s testimony and found that Judy had shown that Kilburn’s death was a direct and natural consequence of his 2008 work injury. The court thus awarded death benefits to Judy. Kilburn’s employer appealed to the Tennessee Supreme Court.