Employers are required under the Americans with Disabilities Act to provide qualified individuals with disabilities workplace accommodations if needed to enable their performance of essential job functions, maintain successful employment, and effectively contribute to the workforce and society. The Equal Employment Opportunity Commission and many federal courts recommend an "interactive process" between the employee and employer, to facilitate effective accommodations. Research demonstrates, however, that often the parties to the process are uncertain of their roles and responsibilities. Similarly, court decisions have not uniformly clarified the specific requirements of the interactive process or alternate best practices to achieve an effective outcome. This article asserts that an occupational therapist with special training in ergonomics may make a significant contribution to identifying and implementing effective workplace accommodations, by mediating the interactive process between employer and employee. This unique role is illuminated by examination of the occupational therapist's professional expertise implementing a successful accommodation (case study) contrasted with an unsuccessful accommodation process that required litigation to resolve. Furthermore, we discuss the role of legal mediation principles in the occupational therapist's practice, suggesting ways to improve accommodation outcomes and avoid litigation. Recommendations for future research and practice are presented.