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In September 2008, 36-year-old Brandon Clark fell eight to 10 feet while working as a carpenter for South Coast Framing, Inc. He suffered neck and back injuries as well as a concussion.

Clark’s workers’ compensation doctor prescribed various drugs to treat these injuries, including Elavil (an antidepressant), Neurontin (a neuronal pain reliever), and Vicodin (a codeine-based pain reliever). In January 2009, Clark’s personal doctor additionally prescribed Xanax (an anti-anxiety medicine) and Ambien (a sleep aid).

On the morning of July 20, 2009, Clark’s wife was unable to rouse him and he was pronounced dead at the scene. At the time of his death, Clark had Elavil, Neurontin, Xanax, and Ambien in his blood. The autopsy surgeon concluded the death was accidental and “is best attributed to the combined toxic effects of the four sedating drugs detected in his blood with associated early pneumonia.” The first two medications were prescribed by the workers’ compensation physician. There was no dispute that Clark died as a result of the combined effects of some of the drugs he took. The dispute centered around which drugs played a role, how big that role was, and why the drugs were prescribed.

The workers’ compensation judge (WCJ) awarded death benefits to the family, finding Clark’s death resulted “due to the medications he was taking for his industrial admitted injury . . . .” The WCJ explained, “it is clear that the [Elavil] prescribed by the doctors for the industrial injury as well as the [Vicodin] acted as concurring causes such that, even without the liberal construction of Labor Code §3202, the death of BRANDON CLARK was a result of the original industrial injury . . . .” The WCJ further found “that the applicant was suffering from continued or chronic pain from his industrial neck, back and head injury and that he was having difficulty sleeping because of that pain,” and that “the doctors prescribed him both the Ambien . . . and the [Xanax] for the inability to sleep.”

The Board adopted the WCJ’s report and denied reconsideration. The Court of Appeal overturned the award, reasoning there was insufficient evidence that the drugs prescribed for the work injury contributed to the death. The California Supreme Court reversed the Court of Appeal’s judgment. in the case of South Coast Framing v WCAB.

The question here is the required nature and strength of the causal link between the industrial injury and death. Tort law and the workers’ compensation system are significantly different. One result of the difference is the role and application of causation principles. Legal causation in tort law has traditionally required two elements: cause in fact and proximate cause. On the other hand, the workers’ compensation system is not based upon fault. “It seeks (1) to ensure that the cost of industrial injuries will be part of the cost of goods rather than a burden on society, (2) to guarantee prompt, limited compensation for an employee’s work injuries, regardless of fault, as an inevitable cost of production, (3) to spur increased industrial safety, and (4) in return, to insulate the employer from tort liability for his employees’ injuries.”

The Court of Appeal concluded that, although Elavil “played a role” in Clark’s death, it was insufficient to prove proximate causation because it was not sufficiently “significant” or a “material factor.” This analysis fails to honor the difference between tort law principles and the application of the workers’ compensation scheme. Tort liability only attaches if the defendant’s negligence was a significant or substantial factor in causing injury. In the workers’ compensation system, the industrial injury need only be a contributing cause to the disability. We have recognized the contributing cause standard since the very beginning of the workers’ compensation scheme such as in the case of Kimbol v. Industrial Acc. Commission (1916) 173 Cal. 351.Death attributable to both industrial and nonindustrial causes may support a death claim, and industrial causation has been shown in an array of scenarios where a work injury contributes to a subsequent nonindustrial injury.

Substantial evidence supported the WCJ’s finding that Elavil and Vicodin, prescribed for Clark’s industrial injury, contributed to his death.