Hagerman v. Gencorp Automotive , 457 Mich. 720 ( 1998 )

Boyle, J.

We granted leave to appeal to examine the Legislature’s use of the phrase “proximate cause” in MCL 418.375(2); MSA 17.237(375)(2), which provides for survivor’s benefits under the worker’s compensation act.¹ We decline to take up the cudgel with regard to the dissent’s scholarly exploration of the evils of judicial legislation or to reconsider the holding in Dedes v Asch, 446 Mich 99; 521 NW2d 488 (1994).² Because the circumstances of decedent’s death were within the range of compensable consequences under subsection 375(2), we reverse the decision of the Court of Appeals and reinstate the decision of the magistrate.

i

Plaintiffs decedent, Keith Hagerman, worked as a millwright for defendant from April 16, 1984, until December 20, 1989. Decedent sustained a back injury at work on August 25, 1987, while trying to move a five hundred pound barrel. He returned to work, but sustained further aggravating injury to his back until he could no longer work as of December 20, 1989. Defendant paid benefits from decedent’s last day of work until his death on March 28, 1990.

As part of the medical treatment of the injury, decedent’s doctor ordered a myelogram to diagnose the extent of the injury and indicate the desirability of surgery. When decedent underwent this diagnostic medical procedure on March 7, 1990, a nurse advised him that successful recovery from the myelogram required that he consume large quantities of water before and after the procedure. As a result of this medical advice, after leaving the hospital, decedent consumed a sixteen ounce glass of water every ninety minutes.

Decedent suffered from high blood pressure for which he was taking the diuretic drag Aldoril. On the nights of March 8 and 9, decedent was hospitalized. It is undisputed that the high water intake, combined with the diuretic action of the Aldoril, depleted the sodium levels in his body, causing convulsions or seizures, that decedent aspirated gastric contents into his lungs as a result of the convulsions or seizures, which caused pneumonia and coma, and that decedent died of cardiac arrest on March 28, 1990.

Decedent’s widow sought death benefits on April 12, 1990. Under subsection 375(2) of the worker’s compensation act, when death is not immediate, the survivor seeking death benefits must show that a work-related injury was the “proximate cause” of the death. The magistrate awarded plaintiff benefits, concluding that the requirements of subsection 375(2) had been met by “[a] chain of medical causation [that was], although unexpected and unusual, . . . clear and unbroken.”³ Citing 1 Larson, Workers’ Compensation, § 13.21, the magistrate reasoned that “[t]he great weight of authority recognizes that the adverse consequences of medical management of a work related condition results in a compensable circumstance.” The magistrate specifically held:

[T]he myelogram was necessitated by the work related injury. It is not an intervening, superseding event, unrelated to the original injury. It does not break the chain of causation. It is but one event occurring in an unbroken sequence of events flowing from, and necessitated by, the injury.

The Worker’s Compensation Appellate Commission reversed, concluding that the death “was the result of medication designed to control his high blood pressure, a preexisting condition. . . . [T]he medication was an independent cause which lead [sic] to plaintiff’s death.” 1993 Mich ACO 845, 847. The Court of Appeals originally reversed in a peremptory order, but, on subsequent plenary consideration, the Court affirmed the wcac, concluding that plaintiff had failed to establish that decedent’s death was proximately caused by the work-related injury. 209 Mich App 667; 531 NW2d 832 (1995).

Plaintiff sought leave to appeal in this Court. We remanded for reconsideration in light of Dedes v Asch, supra, in which we held that the phrase “the proximate cause” in the governmental immunity statute, MCL 691.1407(2)(c); MSA 3.996(107)(2)(c), does not require the plaintiff to establish that the defendant’s conduct was the sole proximate cause of plaintiff’s injuries. 451 Mich 874 (1996). On remand, the Court of Appeals did not apply Dedes. Rather, on further examination of the proximate cause issue, the Court of Appeals affirmed the wcac, concluding that the work-related injury and the myelogram were not substantial factors in the death and that public policy could not support holding defendant to a duty to protect decedent from the harm suffered. 218 Mich App 19; 553 NW2d 623 (1996). Thus, both the WCAC and the Court of Appeals essentially attributed the death to the preexisting medical condition. We conclude that the Court of Appeals erred. The evidence was sufficient to support the magistrate’s conclusion that the injury was the primary moving or substantial cause of the death. We vacate and affirm the decision of the magistrate.

n

A

“[T]he findings of the magistrate are conclusive when supported by substantial, competent, and material evidence . . . .” Goff v Bil-Mar Foods (After Remand), 454 Mich 507, 511; 563 NW2d 214 (1997). “The question we are faced with on judicial appellate review ... is ‘whether the WCAC acted in a manner consistent with the concept of administrative appellate review that is less than de novo review in finding that the magistrate’s decision was or was not supported by competent, material, and substantial evidence on the whole record.’ ” Id., quoting Holden v Ford Motor Co, 439 Mich 257, 267-268; 484 NW2d 227 (1992). In applying subsection 375(2) in the instant case, and upholding the decision of the WCAC, the Court of Appeals employed an erroneous legal framework and based its decision on erroneous legal reasoning. Questions of law are reviewed de novo. Cardinal Mooney High School v Michigan High School Athletic Ass’n, 437 Mich 75, 80; 467 NW2d 21 (1991).⁴

B

“[F]or centuries judges, lawyers and writers have used the phrase ‘proximate cause’ to indicate a cause of which the law will take notice.” Perkins & Boyce, Criminal Law (3d ed), p 774. We attribute no greater or lesser intent to the Legislature in enacting § 375 than to ensure “legally recognized cause.” Id. at 776. Construing the text reasonably to contain all that it fairly means, we find no basis to conclude that legally recognized cause under subsection 375(2) means sole proximate cause.

We need not revisit our decision in Bedes, supra, that “[t]he word ‘the’ before ‘proximate cause’ is not to be read to limit recovery if the plaintiff or another is also a cause . . . [or] to prevent a defendant from claiming comparative negligence . . . .” Id. at 118. Rather, for purposes of the question presented here, we need only observe that our reading of subsection 375(2) is consistent with the dictionary definitions of “a” and “the.”

A. . . . The word “a” has varying meanings and uses. “A” means “one” or “any,” but less emphatically than either. . . . [Black’s Law Dictionary (5th ed), p 1.]

The. An article which particularizes the subject spoken of. “Grammatical niceties should not be resorted to without necessity; but it would be extending liberality to an unwarrantable length to confound the articles “a” and “the.” The most unlettered persons understand that “a” is indefinite, but “the” refers to a certain object. [Id. at 1324.][⁵]

“Proximate cause” generally refers to the “primaiy or moving cause.” Id. at 1103. Therefore, while “a” force might be one of a series of causes, “the” primary or moving force, does not logically or linguistically negate the existence of other forces. Stated otherwise, use of the term “the” to modify the object “proximate cause” does not compel the conclusion that the phrase means sole cause. Recognition of the fact that “proximate cause” means, in broad terms, “primary cause,” requires us to also acknowledge the existence of other legally recognizable causes. Thus, we refuse defendant’s invitation to engraft the word “sole” onto the statute between “the” and “proximate cause” and instead look to the common law to understand the meaning of the phrase “the proximate cause” in the wdca.

1. THE historical context

A conclusion that the Legislature intended sole causation in subsection 375(2) would not only ignore the text of the statute, it would also be inconsistent with concurrent causation principles predating the enactment of the predecessor of subsection 375(2) in 1912.⁶ The law has consistently recognized that there may be more than one proximate cause.

The worker’s compensation act eliminates contributory negligence (unless wilful) as a defense in death cases⁷ and thus explicitly refutes any contention that the Legislature employed the phrase “the proximate cause” in 1912 as a reference to contributory negligence principles that existed at the time. Post at 762-763.⁸ Moreover any suggestion that principles of the doctrine of contributory negligence support the Legislature’s intention to apply a standard of “sole” causation bespeaks a misunderstanding of common-law contributory negligence, which was an affirmative defense that barred the plaintiff from recovery. There is no foundation in the common law for the notion that, because contributory negligence was a defense, the acts of the defendant on which liability was premised were required to be the sole cause of injury. In other words, while contributory negligence was an independent intervening cause that would bar recovery, if there was no contributory negligence, the defendant might or might not be responsible, depending on whether the injury was proximately caused by the act that was alleged to impose liability. It is axiomatic that the existence of concurrent proximate causes at common law did not bar recovery.

As early as Gage v Pontiac, O & N R Co, 105 Mich 335; 63 NW 318 (1895), this Court recognized the existence of concurrent proximate causes contributing to the plaintiff’s injury. The plaintiff was injured when she was thrown from her carriage after the horse drawing the carriage, while crossing a bridge, “made a sudden shy[⁹] to the right,” id. at 339, and went over the side of the bridge. The plaintiff claimed the absence of guardrails on the bridge was the proximate cause of her injuries, while the defendant maintained it was the horse’s shy that proximately caused the injuries. The Court held:

[I]t cannot be said, as a matter of law, that the mere shying of the horse, and not the improper and dangerous condition of the highway, was the proximate cause of the injury. They were apparently concurring causes, — the one, the shying of the horse, where neither party can be said to be in fault; and the other, the defect in the highway, for which, under the finding of the jury, the defendant company is responsible. [Id. at 342.]

The Court supported its decision not to disturb the jury’s decision on appeal with reference to Houfe v Town of Fulton, 29 Wis 296 (1871):

[In that case], it was held that where, besides the defect in the highway, there is another proximate cause contributing directly to produce the injury, which cause is not attributable to plaintiff’s negligence nor that of any third person, the town is still liable in case the jury find that the damage would not have been sustained but for the defect in the way. [Gage, supra at 343 (emphasis added).]

The common-law understanding of concurrent proximate causation has obtained through recent statutory modifications.¹⁰ Thus, in 1946, this Court, relying in part on Gage, unanimously stated:

“Since a concurring cause may be a proximate cause, the rule is that one is liable to respond in damages for an injury which was the natural and probable result of the concurrence of his negligence with the negligence of another, or with an act of God or pure accident, or with an inanimate cause, notwithstanding his lack of responsibility for the other cause.” [Brackins v Olympia, Inc, 316 Mich 275, 281; 25 NW2d 197 (1946).]

The Brackins Court’s discussion of this rule also included the specific acknowledgment not only that there may be more than one proximate cause, but that where this is the case, the negligent wrongdoers cause may be referred to as “the proximate cause”:

“[T]here may be two or more concurrent and directly cooperative and efficient proximate causes of an injury. Negligence which was operative at the time an injury was inflicted may constitute the proximate cause of the injury and be actionable, notwithstanding it concurred with the act of a third person to produce the injury.” [Id. (emphasis added).][¹¹]

Thus, construing the phrase, “the proximate cause” to require sole proximate cause would contradict the common law’s longstanding recognition of the fact that, “there may be two or more concurrent and directly cooperative and efficient proximate causes of an injury.” Id. Absent some persuasive support that the Legislature intended to deviate from the common law’s established recognition of concurrent proximate causation, we have neither textual nor historical basis to construe subsection 375(2) to require a showing of “sole” proximate causation.¹²

Having determined that there is no basis to conclude that the Legislature intended the phrase “the proximate cause” to mean the sole cause, we offer some additional observations before turning to the application of § 375 to the facts before us.

2. THE LIMIT OF PROXIMATE CAUSE IS A MATTER OF PUBLIC POLICY

Proximate causation is not determined by “application of some rule-of-thumb.” Perkins & Boyce, supra at 779. “[SJolutions dependent upon purely mechanical rules would produce absurd results . . . .”¹³ Id. Perkins & Boyce explain the difficult task of determining the boundaries of legally recognized causation:

Whether the term used is “proximate cause,” “legal cause,” “jural cause,” or some equivalent, the idea sought to be expressed is “legally-recognized cause,” which should be promptly tested by the question, — legally recognized for what purpose? The matters of policy which determine just where the limitations of juridical recognition shall be placed upon the broad field of actual cause, are grounded partly upon expediency and partly upon notions of fairness and justice, although even proximate cause must be distinguished from the concept of responsibility. Since the boundary lines of proximate cause are governed by these considerations they may, and in fact do, vary according to the jural consequences of the particular kind of case involved. The line of demarcation between causes which will be recognized as proximate and those which will be disregarded as remote “is really a flexible line.” “Legal causation reaches further” in some types of cases than it does in others. It reaches further in tort actions based upon intentional harm than in those resulting from negligence, and neither of the boundaries so established is necessarily controlling in other types of cases, such as actions for breach of contract, those under Workmens’ Compensation Acts, or criminal prosecutions. [Id. at 776 (emphasis added).]

Thus, the limit of proximate cause is a question of public policy,¹⁴ and its boundaries depend on the type of case in which the Court is asked to determine those boundaries.

c

The parties claim that no authority from this Court establishes the boundaries of proximate causation under subsection 375(2). The defendant argues, consistent with the decision of the Court of Appeals, that we should apply principles of tort law to determine the boundaries of proximate cause under the act, or defer to the wcac’s findings of fact.¹⁵ The Court of Appeals held “that as a matter of public policy defendant should not be held to have a duty to protect plaintiff’s husband from the harm he suffered in the instant case.” 218 Mich App 24. We hold, as a matter of public policy, considering our historical treatment of proximate cause in tort and worker’s compensation cases, that death is within the range of compensable consequences if the injury was a substantial factor in the death, and, we acknowledge, in the absence of a universally applicable test for proximate cause, that such decisions will almost always turn on the facts and circumstances presented in a given case. See, e.g., Stoll v Laubengayer, 174 Mich 701, 704; 140 NW 532 (1913). Here, because the work-related injury began a clear and unbroken chain of events that led to the decedent’s death, the injury was a substantial factor. In other words, we conclude that the magistrate applied the correct legal standard and that the conclusions were supported by competent, material, and substantial evidence on the whole record.

In reaching its conclusion, the Court of Appeals applied the substantial-factor test commonly employed to determine proximate causation in negligence cases:

When a number of factors contribute to produce an injury, one actor’s negligence will not be considered a proximate cause of harm unless it was a substantial factor in producing the injury. . . . Among the factors to be considered is whether the actor’s conduct created a force or series of forces that were in continuous and active operation up to the time of the harm, or created a situation harmless in itself unless acted upon by other forces for which the actor is not responsible. ... We conclude that the back injury and myelogram did not constitute a substantial factor in producing the injury, and so did not proximately cause the injury. [218 Mich App 23 (emphasis added).]

We agree with the Court of Appeals that the substantial-factor test is relevant in determining proximate causation. However, we do not agree with the Court’s application in the instant case, nor with its endorsement of the wcac’s failure to recognize that preexisting conditions will not bar recovery. Section 141 excludes the decedent’s contributory negligence as an intervening cause under § 375. The phrase “proximate cause” in subsection 375(2) does not exclude death benefits where the events leading to the death flow in a clear and unbroken chain of causation; thus, decedent’s death falls within the range of compensable consequences. We reject the decision of the wcac because it fails to comply with the legal requirement that the employer take the employee as he finds him, with all preexisting conditions and frailties, for the purpose of determining compensation.¹⁶ The evidentiary issue is one of remoteness, that is, whether there is sufficient evidence to show a clear and unbroken chain of causation so that the injury was a directly and substantially related cause of the death.

D

Subsection 375(2) adopts a higher standard for awarding benefits than that adopted in § 301.

Subsection 375(2) requires an analysis of whether death was proximately caused by the original injury. Subsection 301(1) requires only the question whether the injury arose out of and in the course of employment. The inquiry into whether a clear and unbroken chain of causation sufficient to show the injury was a directly and substantially related cause of death (subsection 375[2]) is not the same as an inquiry into whether there is a mere causal nexus between the injury or employment (subsection 301[1]).

For example, in Hammons v Highland Park Police Dep’t, 421 Mich 1, 9; 364 NW2d 575 (1984), the Court held death by suicide compensable as a personal injury arising out of and in the course of employment where there was an adequate causal nexus between the suicide and the work-related injury. The question of intervening causation under subsection 375(2) was not presented in Hammons, which was apparently treated as an immediate death case. However, recovery of death benefits in nonimmediate death cases requires an additional hurdle beyond the “arising out of and in the course of employment” causal nexus, namely, proximate cause and the absence of intervening or superseding causes, such as decedent’s wilful conduct, sufficient to break the chain of causation. Thus, for example, death by suicide, if wilful, would appear to be noncompensable under subsection 375(2). The phrase “proximate cause” is an inherently limiting phrase.

Certain general principles govern any inquiry into the applicability of a provision of the worker’s compensation act. Particularly relevant here are two often-cited principles: First, the worker’s compensation act is remedial in nature, and must be “liberally construed to grant rather than deny benefits.” Sobotka v Chrysler Corp (After Remand), 447 Mich 1, 20, n 18; 523 NW2d 454 (1994) (Boyle, J., lead opinion); see, also, Gardner v Van Buren Public Schools, 445 Mich 23, 49; 517 NW2d 1 (1994). Second, for the purpose of determining compensability of an injury or death, courts will require that employers take their employees as they find them. Zaremba v Chrysler Corp, 377 Mich 226, 231-232; 139 NW2d 745 (1966).¹⁷ These general principles apply to both injury and subsequent death cases, as does abrogation of the defenses of contributory negligence, negligence of a coemployee, and assumption of the risk under § 141.

MCL 418.301(1); MSA 17.237(301)(1) provides the general rule for causation under the act:

An employee, who receives a personal injury arising out of and in the course of employment by an employer who is subject to this act at the time of the injury, shall be paid compensation as provided in this act. In the case of death resulting from the personal injury to the employee, compensation shall be paid to the employee’s dependents as provided in this act.

Justice Williams, writing for the Court, eloquently reminded us of the implications of the Legislature’s selection of the “arising out of and in the course of employment” standard for causation in supplying a system for compensation of injured employees and, in cases of death, the dependents of those employees:

In fact, it might be said that workmen’s compensation, like the gentle rain from heaven, falls upon the just and unjust alike so long as the injury arose out of and in the employment ambience. [Thomas v Certified Refrigeration, Inc, 392 Mich 623, 637; 221 NW2d 378 (1974).]

Section 301 imposes liability where the injury arises out of the employment without reference to fault. Subsection 375(2) likewise imposes liability without respect to fault, but requires closer examination of the causal connection. However, in concluding that the defendant’s preexisting condition was the sole legally causative factor in his death, the approach taken by the Court of Appeals and the wcac elides the principle that an injured employee’s preexisting weaknesses, here the decedent’s high blood pressure, are irrelevant to the inquiry into causation, and it avoids both the legal and factual inquiry regarding independent intervening cause.

The magistrate correctly observed that “[t]he great weight of authority recognizes that the adverse consequences of medical management of a work related condition results in a compensable circumstance.” Larson states:

It is now uniformly held that aggravation of the primary injury by medical or surgical treatment is compensable. Examples include exacerbation of the claimant’s condition, or death, resulting from [for example] antibiotics, antitoxins, sedatives, pain-killers, anesthesia, electrical treatments, or corrective or exploratory surgery. [Larson, supra, § 13.21(a), pp 3-699 to 3-711.]

We have followed this rule at least since our decision in Oleszek v Ford Motor Co, 217 Mich 318; 186 NW 719 (1922). There, we held that the plaintiff could recover where he ultimately lost his leg because of infection after suffering an injury of his ankle at work. The plaintiff’s original injury was fairly minor, but subsequent infection after several attempts at treatment resulted in amputation. We stated:

Where there is a right of recovery due to the original injury and the disability at the time of the hearing is directly traceable thereto, the intervention of other and aggravating causes by which such disability has been increased, if the claimant is not himself to blame therefor, is no bar to his recovery. . . . The rule is thus stated . . . :

“Where the immediate agency causing the death or second injury is one which the first ir\jury rendered it essential to employ, the employer has been held liable for the resulting death or injury.” [Id. at 321-322.]

Thus, we concluded that the relevant inquiry focused on whether “disability . . . was caused by, or directly traceable to, the injury resulting from the accident,” id. at 322, and precluded plaintiff from suing for damages at law, i.e., for negligence. The Court of Appeals correctly recognized that under Oleszek, “[a]n employer is hable for additional injuries or complications that result when an employee submits to medical procedures necessitated by work-related injuries.” 218 Mich App 22-23. However, the Court of Appeals and the wcac erred in denying compensation on the legal basis that, because decedent had a preexisting condition, the results here were too remote.

In the presence of a causal relationship not so attenuated that a court can permissibly conclude that the original injury was not a moving or substantial cause of the ultimate injury, a court cannot conclude under traditional definitions of proximate cause that necessary medical treatment that resulted in death is not legally cognizable. Larson’s view of the uniform rule regarding aggravating medical consequences and Oleszek is consistent with these definitions.

Moreover, it is well established that an employee has a “duty to minimize . . . damages by obtaining proper medical or surgical treatment.” Smith v Jones, 382 Mich 176, 186; 169 NW2d 308 (1969). Absent unreasonable risk, an employee must submit to reasonable medical treatment or “release his employers from the obligation to maintain him.”¹⁸ Kricinovich v American Car & Foundry Co, 192 Mich 687, 690; 159 NW 362 (1916). See, also, Workers’ Compensation: Reasonableness of employee’s refusal of medical services tendered by employer, 72 ALR4th 905. In light of the fact that injured employees are required by law to submit to medical treatment, we decline to conclude that the Legislature intended to curtail the right to death benefits by imposing a requirement of sole proximate cause where medical complications result in death. We reaffirm our holding in Oleszek, that the consequences of medical treatment, even where those consequences result in death, are within the range of compensable consequences where the chain of causation is clear and unbroken.

Although Oleszek did not directly involve nonimmediate death benefits under subsection 375(2), the Court’s reference to death is consistent with cases decided directly under subsection 375(2) or its predecessors, before and after Oleszek.

In Swanson v Oliver Iron Mining Co, 266 Mich 121, 122; 253 NW 239 (1934), the plaintiff sought death benefits in the form of “the 300 weeks’ compensation that had been awarded to her [deceased] husband . . . .” The decedent was injured in an explosion at the mine where he worked. He recovered and was able to walk on crutches, but did not work again. The decedent received compensation for the injury from 1927 until his death in 1932.¹⁹ Justice POTTER, writing for a unanimous Court, addressed the exact issue we address today: “whether the injury suffered by . . . plaintiff’s husband . . . was the proximate cause of his death . . . .’’Id. at 122. The Court held:

The question is whether the injury accelerated his death; whether, by reason of the injury suffered by him, his death occurred sooner than it probably otherwise would. There was testimony indicating the injury suffered lowered his vitality and probably shortened his life. This was sufficient. [Id.]

In Neumeier v City of Menominee, 293 Mich 646; 292 NW 511 (1940), the Court addressed the death benefits question of proximate cause again and sustained an award of death benefits. The decedent dropped a plank on the toes of his right foot at work in 1936. He failed to seek immediate medical attention, and, within a month, gangrene developed, “necessitating the amputation of one toe.” Id. at 648. The gangrene progressed and the decedent’s right leg was amputated approximately one month later. While this terminated the infection, the decedent died about sixteen months later. “The causes of death were thrombosis of the popliteal artery of his left leg, chronic myocarditis, arteriosclerosis and toxemia from a tumor in his mouth.” Id. at 648 (emphasis added). In determining “whether . . . there [was] any competent testimony to support the . . . award,” id., the Court rejected the argument that the death benefits statute required a showing of sole proximate causation and sustained an award under 1929 CL 8428, a predecessor of § 375:

It is true that [the treating physician’s] testimony does not indicate that the injury was the sole cause of death. But in view of the decisions of this court, if there is competent testimony that the injury accelerated his death it is sufficient to be a proximate cause under the statute .... [Id. at 649.][²⁰]

The Court addressed the same issue again in Byrne v Clark Equipment Co, 302 Mich 167; 4 NW2d 509 (1942). There, the decedent developed a hernia at work that required surgical repair. However, during the operation, the surgeon also decided to remove the decedent’s appendix for reasons without apparent connection to the hernia injury. The decedent developed a postoperative infection and died of peritonitis. Plaintiff, decedent’s wife, sought death benefits under a predecessor of subsection 375(2), 1929 CL 8428. Applying the proximate cause language in that section, the Court vacated an award of death benefits because the administrative tribunal found “that the source of the infection resulting in the death of the decedent is unknown and that it is not necessary to determine the source of such infection.” Byrne at 176 (emphasis added). The Court held:

[P]laintiff has failed to sustain the burden of proving that the original hernia injury, through direct causal connection with the operation and resulting infection, was the proximate cause of her decedent’s death. [Id. at 177.]

The Byrne Court reasoned that an award would be appropriate if plaintiff could show proximate cause through a direct causal connection between “the injury causing the hernia and the infection resulting from the operation for its repair,” but that an award would not be appropriate if the infection resulted from the independent appendix removal procedure. Id.²¹ Because the record did not reveal any evidence regarding the source of the infection, the plaintiff could not show that death was proximately caused by the injury, and an award could not be sustained.

The conceptual framework uniting cases involving worker’s compensation death benefits claims is acceleration of death on the basis of direct causal connection with the work-related injury. Whether concluding that acceleration of death is sufficient or that a direct causal connection is required, from the earliest days of this Court’s interpretation of the worker’s compensation act, see, e.g., Fitzgerald v Lozier Motor Co, 187 Mich 660, 666; 154 NW 67 (1915), through Oleszek (1922), Swanson (1934), Neumeier (1940), Byrne (1942), and the other cases cited above, the decisions present a clear and consistent understanding of proximate cause. In view of the overwhelming weight of the authorities, within our state and elsewhere, see, e.g., Anderson v Industrial Ins Comm of Washington, 116 Wash 421; 199 P 747 (1921), we reject both the conclusion of the Court of Appeals in sustaining the decision of the wcac and the sole causation approach of the dissent.²²

Where the plaintiff can show a direct causal connection between the work-related injury and the subsequent death, or a sequence of events that, while unexpected and unusual, are not uninterrupted by causes so unexpected as to break the chain of causation, the plaintiff has met the threshold requirement for proximate cause as a matter of law under subsection 375(2). Testimony may establish a basis for finding that the death was not factually related to the original injury, but preexisting medical conditions are not sufficient as a matter of law to break the chain of causation.²³ Likewise, aggravating medical consequences will not break the chain of causation where the injury necessitates foreseeable medical treatment and there is an evidentiary foundation that supports the conclusion that there was a clear and unbroken chain of events leading to death.

E

We find the facts and circumstances of this case to be more like Neumeier than Byrne. The magistrate held that the death arose directly as a result of the decedent’s compliance with the law and the advice of medical professionals in undergoing a myelogram and drinking plenty of water thereafter in order to properly treat or diagnose his work-related back injury. We agree with the magistrate’s interpretation of the law, and we find his award supported by competent evidence, i.e., Dr. Dodson’s report/testimony. The fact that decedent ingested an excessive amount of water is, on this record, irrelevant because contributory negligence is not a defense and defendant does not contend that decedent’s conduct was an independent intervening cause. That decedent was complying with the legal requirement that he undergo reasonable medical treatment or forfeit his right to benefits precludes us from concluding that benefits are not payable where the complication resulting from the treatment ordered was death.

The magistrate correctly concluded that decedent’s death was sufficiently traceable to the work-related injury to fall within the compensable range of consequences under subsection 375(2). The magistrate’s ruling amounts to a finding that each step in the chain of causation was dependent on the existence of the work-related injury and its required treatment and that there was no intervening superseding cause sufficient to break the chain of causation. Consistent with the text of subsection 375(2), and long-established jurisprudence on the meaning of proximate cause, we decline defendant’s invitation to read the phrase “proximate cause” to mean sole cause so as to yield a different result, and we specifically reject the notion that decedent’s preexisting medical condition may be considered a superseding cause under these circumstances.

m

The magistrate applied the correct legal standard in considering whether the chain of medical causation was “clear and unbroken” and whether that chain established that the death resulted from “the adverse consequences of medical management of a work related condition . . . .” The evidence supported the magistrate’s conclusion that the death was sufficiently traceable to the work-related injury to establish compensability. We reverse the decision of the Court of Appeals and reinstate the magistrate’s award of benefits.

Mallett, C.J., and Cavanagh and Kelly, JJ., concurred with Boyle, J.

1 MCL 418.375; MSA 17.237(375) provides in relevant part:

(1) The death of the injured employee before the expiration of the period within which he or she would receive weekly payments shall be considered to end the disability and all liability for the remainder of such payments which he or she would have received in case he or she had lived shall be terminated, but the employer shall thereupon be liable for the following death benefits in lieu of any further disability indemnity.

(2) If the injury received by such employee was the proximate cause of his or her death, and the deceased employee leaves dependents . . . , the death benefit shall be a sum sufficient ... to make the total compensation for the injury and death exclusive of medical . . . and rehabilitation services, and expenses . . . equal to the full amount which such dependents would have been entitled to receive under the provisions of section 321, in case the injury had resulted in immediate death.

MCL 418.321; MSA 17.237(321) provides for computation of death benefits at eighty percent of the employee’s after tax weekly wage for a period of five hundred weeks for persons wholly dependent on the decedent and for benefits in proportion to the level of dependency for persons partially dependent on the decedent.

2 We decline the invitation to reconsider Bedes, which involved a different context. Furthermore, the relevance of a discourse on the obligation to effectuate legislative intent is not apparent, given that the dispute here is really a matter of how the law ought to be applied to the facts. Whether we characterize the standard as one of primary causation, consistent with our jurisprudence on the subject, or as one of “sole” proximate causation, consistent with the dissenting opinion, the result would be the same. Although the dissent implies that some “extrinsic force,” 'post at 759, intervened to cause the death so that the injury resulted from the unfolding of “a series of tragic and unlikely events,” id. at 754, the dissent never identifies the extrinsic force interrupting the chain of causation and differentiating this case from our earlier jurisprudence. The decedent’s hypertension and medication cannot be so identified because they are part of a preexisting condition. The defendant takes the employee as he finds him. The myelogram was necessitated by the injury, making it, along with its complications, a foreseeable consequence of the injury that does not interrupt the chain of causation. Decedent’s ingestion of water indicates compliance with the necessary treatment (another foreseeable consequence of the injury), and an allegation of excessive ingestion would amount to an allegation of contributory negligence not legally recognizable under the wdca. None of the relevant “forces” was “extrinsic” (or a superseding cause) because none of them could have caused the death alone or concurrently with the other causes independently of the single occurrence that irrefutably set in motion the chain of events leading to Mr. Hagerman’s death. Thus, even if we adopted the “sole” proximate causation standard advocated by defendant and the dissent, the conclusion would be inescapable that the single legally recognized primary and proximate cause of Mr. Hagerman’s death was the work-related irqury that is not too remote, given the clear and unbroken nature of the chain of events directly tying the death to the injury. Although tragic and unlikely, the chain is direct and the consequences are not so remote as to preclude liability under subsection 375(2).

3 The magistrate found that decedent sustained a work-related back injury, that the work-related injury necessitated the myelogram, that decedent’s ingestion of large amounts of water was consistent with the medical recommendations he received in association with the myelogram, and that he died from a combination of sodium deficiency and aspiration pneumonia resulting from the myelogram.

4 While “factual determinations of the commission, if acting within the scope of its powers, shall be conclusive,” Goff, supra at 512, de novo judicial review is appropriate where an incorrect legal standard is employed. The wcac concluded that the magistrate “applied an incorrect legal standard,” 1993 Mich ACO 846 and reversed the award of death benefits because it believed that death “was the result of medication designed to control [decedent’s] high blood pressure, a preexisting condition.” Id. at 847. As explained below, the view that attributing the death to a preexisting condition defeats causation under these circumstances is legally erroneous.

5 The dissent questions our reference to Black’s. However, we find no real inconsistency between its discussion and that to which the dissent refers. Given that “proximate cause” is a term of art, resort to a legal dictionary in a discussion of its meaning and application is appropriate.

6 Proximate cause, whether informed by the substantial factor test, or the discussion of intervening and superseding causes, by acknowledging the possibility of concurrent proximate causes, is foreign to the notion that some factor must be the sole proximate cause. See, e.g., Welch v Jackson & Battle Creek Traction Co, 154 Mich 399, 407-408; 117 NW 898 (1908).

7 MCL 418.141; MSA 17.237(141) states:

In an action to recover damages for personal injury sustained by an employee in the course of his employment or for death resulting from personal injuries so sustained it shall not be a defense:

(a) That the employee was negligent, unless it shall appear that such negligence was wilful.

(b) That the injury was caused by the negligence of a fellow employee.

(c) That the employee had assumed the risks inherent in or incidental to, or arising out of his employment, or arising from the failure of the employer to provide and maintain safe premises and suitable appliances.

8 The dissent contends that Stoll v Laubengayer, 174 Mich 701, 706; 140 NW 532 (1913), established the general rule of the day that proximate cause was defined as “the immediate efficient, direct cause preceding the injury.” However, as noted below, that was merely one of several definitions considered in Stoll, and the rule to be gleaned from that case is that proximate cause is a case-by-case analysis. The Stoll Court recognized that, as of 1913, the year after enactment of the wdca, “[n]o general or authoritative definition [of proximate cause] ha[d] been evolved . . . .” Id. at 704. Nevertheless, the language cited by the dissent does not require proof of the sole cause or the last cause preceding the injury. Rather, the key word being “efficient,” it references primary cause. Moreover, that description fits the facts and circumstances of Stoll because it described the influence of plaintiff’s decedent’s act in voluntarily riding her sleigh down an incline.

9 The Random House College Dictionary defines “shy,” as it relates to horses, as “to start back or aside, as in fear.” Id. at 1220.

10 See, e.g., MCL 600.6304; MSA 27A.6304 (comparative fault). By utilizing pure comparative negligence, the Legislature leaves defendants seeking to avoid liability altogether with one argument regarding the plaintiffs conduct — that the plaintiff was one hundred percent at fault for the alleged damages, i.e., that plaintiff’s conduct was the sole cause of the injuries for which he seeks recovery.

11 Lest there be any doubt about the applicability of these concurrent proximate causation rules at the time the Legislature enacted the predecessor to subsection 375(2) in 1912, see Cavanaugh v Michigan Central R Co, 175 Mich 156, 160; 141 NW 539 (1913), where Justice Bird’s dissent reflected on Justice Cooley’s treatment of the issue in his treatise on Torts:

“If the original act was wrongful, and would naturally, according to the ordinary course of events, prove injurious to some other person or persons, and does actually result in injury through the intervention of other causes which are not wrongful, the injury shall be referred to the wrongful cause, passing by those which were innocent. . . . It is equally true that no wrongdoer ought to be allowed to apportion or qualify his own wrong, and that, as a loss has actually happened whilst his own wrongful act was in force and operation, he ought not to be permitted to set up as a defense that there was a more immediate cause of the loss, if that cause was put in operation by his own wrongful act. To entitle such party to exemption, he must show, not only that the same loss might have happened, but that it must have happened if the act complained of had not be done . . . .”

Although the Cavanaugh majority disagreed regarding the result that Justice Bird would have reached, the discussion from Cooley authoritatively supports our understanding of the nature of the proximate cause inquiry circa 1912. Cf. Stoll, n 8 supra at 704 (observing the absence of a general and authoritative definition of proximate cause applicable in all cases, instead looking to the peculiar facts and circumstances of the given case).

12 Indeed while the dissent suggests that our holding launches a judicial missile of unbridled judicial activism that will precipitate further revisionist thinking, the claim is vastly overblown. The dissent is unable to cite a single case standing for the proposition that “the proximate cause” means sole proximate cause. The claim that we are “fundamental[ly] unwilling[] to apply the plain meaning of the text as written by the Legislature,” post at 756, is both unfounded and ironic. It is the dissent that would conflate the word “the” into “sole” to fundamentally alter the legal landscape created by the Legislature. Our understanding of the phrase “proximate cause” is the understanding expressed by this Court before, after, and contemporaneously with enactment of the wdca. This understanding informed the context in which the act was written. Given that “proximate cause” is, as the dissent acknowledges, a “term of art,” id. at 752, that has its origins in the common law, we conclude that the Legislature’s understanding of the phrase was consistent with this Court’s jurisprudence applying it case by case, and not with the dissent’s insistence on the unsupportable and unsupported conclusion that “the” means “the sole.” The heroic effort of the dissent notwithstanding, the inquiry into proximate causation is a question of remoteness, not semantics.

13 Indeed, it was noted about the time the Legislature enacted the worker’s compensation act that “all attempts hitherto made at laying down universal tests [for proximate cause] of a more definite and more specific nature have resulted in propounding rules which are demonstrably erroneous.” Smith, Legal cause in actions of tort, 25 Harv L R 303, 317 (1912). Even earlier, Chief Justice Cooley noted in passing, “The application of the rule that the proximate, not the remote cause is to be regarded, is obscure and difficult in many cases . . . .” Lewis v Flint & P M R Co, 54 Mich 55, 64; 19 NW 744 (1884).

14 See, e.g., Davis v Thornton, 384 Mich 138, 146; 180 NW2d 11 (1970) (“Causation is a process of logical determination, while the significance of the connections — remoteness—is a policy determination”); Palsgraf v Long Island R Co, 248 NY 339, 352; 162 NE 99 (1928) (Andrews, J., dissenting) (“What we do mean by the word ‘proximate’ is that, because of convenience, of public policy, of a rough sense of justice, the law arbitrarily declines to trace a series of events beyond a certain point”); see also, Williamson v Waldman, 150 NJ 232, 245; 696 A2d 14 (1997) (“[T]he limit of proximate cause is, ultimately, an issue of law and similarly entails a consideration of public policy and fairness”); Marsh v Commonwealth Land Title Ins Co, 57 Wash App 610, 622; 789 P2d 792 (1990), review den 115 Wash 2d 1025 (1990).

15 See Goff, supra at 511-512.

16 In Stoll, supra at 705, while recognizing that this Court had “never apparently attempted to accurately define the term ‘proximate cause,’ ” the Court acknowledged the principle announced in Borck v Michigan Bolt & Nut Works, 111 Mich 129, 133; 69 NW 254 (1896):

The damage to be recovered in an action must always be the natural and proximate consequence of the wrongful act complained of. If a new force or power has intervened, of itself sufficient to stand as the cause of the mischief or injury, the first must be considered as too remote.

We respectfully disagree with the dissent’s conclusion that the injury was too remote in this case. Under these circumstances, neither the preexisting hypertension and medication therefor nor the decedent’s compliance with medical advice he received was sufficient to stand alone as the cause of the death, independent of the injury necessitating the myelogram.

17 The rule is well settled and generally accepted. See, e.g., In re Madden, 222 Mass 487, 493-494; 111 NE 379 (1916).

18 We find defendant’s argument that benefits were paid voluntarily and that no one forced or persuaded decedent to undergo the myelogram unpersuasive. The obligation to mitigate is an independent obligation imposed on a plaintiff by law.

19 The decedent in the present case died only three months after the injury.

20 The Neumeier Court cited Rickard v Bridgeman-Russell Co, 288 Mich 175, 178; 284 NW 689 (1939), in which the question of proximate cause in a death benefit case was again held to turn on whether the injury probably accelerated death. The Rickard Court references five more cases that support this understanding of proximate cause in worker’s compensation cases. For example, in Waite v Fisher Body Corp, 225 Mich 161, 163; 196 NW 189 (1923), the Court defined proximate cause as “ ‘the cause which directly set in motion the train of events which brought about the death.’ ” See also Monk v Charcoal Iron Co of America, 246 Mich 193, 195-196; 224 NW 354 (1929) (sustaining an award of death benefits in an immediate death case while recognizing that the shock and excitement contributing to the decedent’s heart attack, in the presence of a possible “previous [heart] disease,” need not have been “the sole, proximate cause”). Id. at 197.

21 The dissent overlooks this distinction in its analysis of Byrne by oversimplifying the facts of that case. Moreover, the dissent fails to identify what independent factor in this case caused the decedent’s death or broke the chain of causation. In Byrne, there was no recognizable legal relationship between the injury and the death because of the ambiguity raised by the doctor’s decision to remove plaintiff’s appendix independently of the work-related injury. Thus, the Court applied the following rule:

“Where two inferences equally consistent with the facts arise . . . , one involving liability on the part of the employer . . . and the other relieving him from liability, the [plaintiff] must fail.” [Id. at 178.]

In this case there is a clear and legally recognizable relationship among the injury, the ordered medical treatment, and the ultimate resulting complication of death. If the injury required a myelogram, and, in the process of administering that treatment, the doctor engaged in a course of conduct that constituted an independent intervening cause as a matter of law or if there was testimony that the conduct might have caused decedent’s death, the situation would be entirely different because, like Byrne, the case would involve an ambiguity relevant to independent, intervening causation that might rise to the level of superseding cause. This is not such a case. This case involves a clear and unbroken chain of events, set in motion by the work-related injury, and not so attenuated as to justify a conclusion that the injury was too remote to stand as the legal cause of death under the wdca.

22 Welch, Worker’s Compensation in Michigan: Law & Practice, § 7.6, p 7-8, asserts that Noble v Ford Motor Co, 152 Mich App 622; 394 NW2d 50 (1986), altered our jurisprudence in this area. While we agree with the Noble Court that subsection 375(2) requires an inquiry separate and distinct from that which occurs under § 301, we find that the result in that case, that plaintiff had failed to show proximate cause, was driven by the plaintiff’s inability to differentiate to any extent between the decedent’s cigarette smoking and his occupational health risks for the purposes of showing causation. We agree with the results in Noble and in Barnes v Campbell, Wyant & Cannon Foundry Co, 188 Mich App 46; 469 NW2d 7 (1991), which also involved a decedent who was a heavy smoker. However, because we find them similar to Byrne, we would not interpret them as departing to any great extent from our earlier proximate cause jurisprudence.

23 Our opinion in Dean v Chrysler Corp, 434 Mich 655; 455 NW2d 699 (1990), is not implicated here.