OBJECTIVE: To assess medical costs of occupational injuries and sources of payment among Hispanic and non-Hispanic construction workers. METHODS: More than 7000 construction workers, including 1833 Hispanic workers were examined using the Medical Expenditure Panel Survey, 1996 to 2002. Univariate and multivariate analyses were conducted using SUDAAN. RESULTS: Annually, work-related injuries in construction cost $1.36 billion (2002 dollars), with 46% paid by workers' compensation. Compared with non-Hispanic workers, Hispanic workers were 53% more likely to have medical conditions resulting from work-related injuries, but 48% less likely to receive payment for medical costs from workers' compensation (P < 0.05). CONCLUSIONS: This study suggests an urgent need to reform the current workers' compensation system to reduce the burden shifted to injured workers and society. Such reforms should include easier access and more assistance for Hispanic and other immigrant workers.