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When OTs Wore White Shoes

OTs Performing On-Site Industrial Evaluations

Published May 27, 2014 8:51 AM by Debra Karplus
In my four decades as an occupational therapy practitioner, I have often felt conflicted and torn between two worlds; decisions based on the behalf of the facility or agency that was paying me, often clashed with what was best for my client or patient.  Those years in the 1990s when I performed industrial evaluations on the job stand out, as I often felt emotionally pulled in two different directions.

During these years, I was hired as an independent contractor by a company that utilized the services of me as well as other occupational and physical therapists, and professionals from other specialties.  The independent contractor status is a distinctly different arrangement than being an employee according to the Internal Revenue Service (IRS) and has important tax consequences specifically for independent contractors like me. My job was to perform evaluations on-site in workman's compensation cases where an employee claimed to be injured on the job.

The chain of command in this arrangement involved several parties.  Insurance companies would contract with the industrial evaluation company, such as the one who employed my occupational therapy services, and I would be asked to observe the person on the job who was allegedly injured doing this job, and assess related gross motor, fine motor, perceptual motor, and cognitive functioning to determine if the person was able to continue in that job, and if so, I made specific recommendations regarding necessary accommodations that could be made to improve this person's functioning on the job.

The Americans with Disabilities (ADA) was still relatively new legislation when I did worked in the industrial arena.  I should mention that my work specifically did not involve occupational therapy treatment of any kind; I was simply to evaluate and recommend and report to the workman's comp insurance provider via the company that wrote my check.

Perhaps in some other setting or situation the assessments and recommendations I provided wouldn't have seemed so murky.  I was always very conscious of who was paying my bill, indirectly the insurance company.  It was always heavy on my mind that the power of my word could quickly put the allegedly injured person out of work needlessly, and I have often wondered if my assessments and recommendations could have been more compassionate.  That sort of pressure on the job was perhaps more intense than the stress I may have felt in any other of the numerous settings where I have worked over the years.

My feelings of conflict continued long after I left that arena and began working in public schools as an occupational therapist.  Occasionally I would encounter the family of the person who I had evaluated in the factory years before and wonder if things turned out okay, but it was never appropriate to ask.

Being an occupational therapist can be very stressful at times, but sometimes not for the reasons that onlookers might suspect.  I have always loved being an OT, but sometimes the professional decisions we must make are not particularly clear cut.


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