On-site occupational and physical therapy in back-to-work treatment used to be a kind of "let-me-see-what-you-do" thing near the end of therapy. The OT would accompany the employee to the job site to see what his job entailed. The employee would go through his routine to give the therapist an idea of how he or she might need to adapt the work area or tasks to fit the recovering worker who was still getting paid by Workers' Compensation.

The time it took to get to this point could vary significantly, and the longer it took, the more expensive it was to both employer and employee.

Within the past few years, state Workers' Comp boards have been switching to a new paradigm called "transitional work," in which employees return to their workplaces-and their paychecks-when they are medically cleared to work, before their injuries have completely healed.

The workers are doing real job tasks, not simulated ones, and are guided by therapists to build up their strength and skills and avoid further injury. This period lasts for about three months.

This is a deal made in heaven for OTs. They are working in natural environments with people who already identify with their jobs. Research has found these people to be more motivated to get better, less likely to malinger and ready to go off the WC roles a few weeks faster than their counterparts.

Since Workers' Compensation pays a good portion of the bills for occupational therapy in industrial rehab settings, advocating for the occupational approach is worth your while. The facts are all on OT's side this round.

Ohio was one of the first states to fully embrace the transitional work concept. Its Bureau of Workers' Compensation (BWC) advertises grants for businesses that want to take advantage of the transitional work option.

A BWC study showed impressive statistics. On average, transitional work programs saved Ohio businesses $1,108 a case in compensation claim costs and an average of almost $140 in medical costs per claim. In addition, injured workers at workplaces with the transitional program went back to their regular jobs 10 days sooner than employers who didn't have a program.

Ohio's BWC works with managed care organizations to give employers the information they need to handle claims and offers sample policies and procedures, training materials, and forms and letters.

As far as employees are concerned, maintaining their co-worker relationships and their full paychecks during recovery is a strong motivator to get into the program.

"Employee and/or union support are essential for successfully changing a company's work culture," the compensation board notes in an online ad. "A BWC small business advocate is also available to help you overcome barriers between labor and management."

Ohio firms that have switched to this system seem very happy with it.

The Ohio BWC says some statistics show that "decreased productivity, increased hiring and training costs, higher overtime expenses, increased legal costs, lowered morale and loss of business and customer goodwill" incurred during a long-term claim are four times greater than the direct cost of the claim itself.

And workers lose even more. In California, a 2001 report by the Institute of Industrial Relations (IIR) at the University of California-Berkeley noted that for workers who sustain permanent partial disabilities, California Workers' Comp benefits were more than 30 percent lower over a five-year period than beneficiaries' after-tax pay would have been.

"Getting back to work may be the best way for injured workers to avoid financial losses," the IIR told the Commission on Health and Safety and Workers' Compensation in 2001. "This is true for workers from both insured and self-insured companies... The greatest losses occur when the disabled worker loses his or her job and cannot find work that pays as much as the worker was paid previously, or cannot find any work at all."

The report notes that there are three main obstacles that get in the way of getting people back to work sooner:

• Treating physicians have no knowledge of the worker's job or of temporary jobs he or she might undertake while recovering.

• Employers don't know what specific changes could be made in the workplace to enable the injured worker.

• Injured workers are not told what they might do in order to return to work.

  No one-employer, claims administrator, or treating physician-is required to "take specific steps designed to return the worker to work, either through placement with the same employer or through vocational rehabilitation services," the IIR report said.

The transitional work approach actually enhances OT's place in industrial rehab. Readers who want to find out if their Workers' Compensation boards have embraced this approach, should check the Internet to see. If not, become an advocate for it. It may be the best thing that has happened to OT in the past five years.

E.J. Brown is editor of ADVANCE.