Rousmaniere: Who Are These Injured Immigrants?

Peter Rousmaniere

What is it like to be a low-wage immigrant worker in the US and suffer a work injury? Whether legal or illegal, modestly educated in a formal sense but with well-honed practical skills and resolve, this person works at a job that many native-born Americans may shun. reporter Phil Yacuboski wrote on May 2 that one injured immigrant worker who has litigated his claim in Minnesota received permission from the judge to testify via video, because he fears being deported. Immigration and Customs Enforcement (ICE) has been arresting people when they show up for civil court and immigration hearings.

Some 27 million foreign-born people work in America, about 17% of the workforce. Among major occupations with no need for a high school degree or much contact with the public, immigrants fill about 40% of the jobs.

They include jobs on farms, construction sites, warehouses, in kitchens, and for building cleaning and maintenance. Roughly half these workers are undocumented.

The people in work comp who best know these workers when they get injured are case managers. So, I sought out two of them.

Ginger Medina is a Spanish-speaking medical case manager for Coventry. She lives in Massachusetts. She says that she’s “worked with immigrant workers my entire nursing career.” She spent a decade working at a hospital in Texas, which has a large immigrant population. “But I became aware,” she told me, “of the complexities of workers’ compensation and immigrants when I moved to New England 11 years ago and started working with that population.”

Most of Medina’s immigrant patients are from Central and South America. In New England they don’t have family nearby and are isolated. In Texas, in contrast, immigrant workers live largely with intact families and use established networks for medical care and social support.

The injured workers she helps now include house cleaners and construction laborers. Only two she can think of use English at work. Some have a commercial driving license and understand a lot more than they speak.

In San Antonio, where she had worked, the majority of the immigrants she encountered came into the US illegally from Mexico, crossing the border on foot. In Massachusetts, the majority come from Central and South America, flying into the US on vacation and then over-staying. In her experience, they find work through other immigrants already employed. Those who work in restaurants or hotels have generally been here a longer and are established in a permanent living situation. These jobs are considered better because they are not doing manual labor outside. Many workers say their employer does not provide benefits.

The workers socialize with fellow immigrants, usually those they work with or people they meet at church. She told me that everyone is trying to send money home. “When women leave their children behind in their home country they are very motivated to send as much money home as possible. I have had very few injured women patients who have not gone back to the same job. In comparison, 25% of my male injured workers don’t go back to same job. “

Most of the immigrant workers plan to stay in the US, and want to bring their families here. However, most don’t know how to gain citizenship, and don’t even know what steps to take to find out how to do so. Severe injuries change their expectations. If the injury is severe enough, most will take a settlement and go back to their home country.

The undocumented workers Medina helps either do not fear risk of deportation or do not express concern to her. In New England, there are many organizations that are designed to support undocumented immigrants, to help them get fair wages, be protected and put them on the path to get a green card.

For another perspective, I turned to Nanesha Courtney, who works for Broadspire. Her team of nurses and vocational counsellors cover Washington and other western states. She says when she began working in our field twenty years ago, “it was not uncommon for between 80-95% of my caseload to be non-English speaking.” Courtney does not speak another language. In that respect, the great majority of claims professionals can identify with her.

She has helped injured workers in the Yakima Valley, where the majority were Hispanic on apple, produce, lettuce and tomato farms. Her assignments now include the Oregon and Washington coast, where Russians work in fish processing plants.

In the Yakima Valley, many of her migrant farm worker clients follow work based on season, so they may be in town for a few months. They often were paid either piece work or by the field. Many sent most of their earnings back to their families in their home countries. And many lived with intact families. The spouse might work in hotel cleaning. The whole family might work in the field, including children as young as eight.

Workers often hold down two or three jobs. But with the injury benefits being paid for only one job, finances were challenging. She said, “A lot of my workers were in housing supplied by one employer, and if no one else in the family worked on the farm there was danger of losing farm-supplied housing.”

She finds that that no matter what the individual’s immigration status is, most injured workers just want to get back to work. She has not seen much variation among the individual populations based on geographic region. “The goal to take care of their family is consistent.”

Not being bilingual, Courtney employs onsite interpreters, who ideally attend the doctor encounters. “As for telephonic interpreters — I do not see any limitations per se, but one needs to get used it. When the interpreter is face-to-face, we can communicate better. The telephonic interpreter does not pick up the visuals, the facial expressions.”

She has sought out advice from someone who knows the culture of the worker. That person might work at a community college. “I have access to many individuals who are culturally competent.”

I asked Courtney about barriers in healthcare. One, she told me, involves what the worker is able or willing to disclose. “A lot of our clients are farm workers who stopped school after the second grade. They may learn about healthcare for their condition from their teenage children. And they do not want to be thought of as weak, especially injured men in the presence of a male doctor. It’s not uncommon that they will tell me a certain task hurts but they will not say that to their doctor.”

The United States is politically deadlocked over immigration policy. The leading Republican reform bill in the Senate, proposing a demanding points system for immigrants, would essentially ban any of these low-wage workers from ever getting a green card, much less citizenship. Meanwhile, employers’ demand for temporary visa workers has been surging.

Any progress in forging a consensus about immigration’s future will likely not originate in Washington, but at the community level. For the workers’ compensation community, that means progress one injury at a time.

Here is an employer’s guide to safety and health in a diversified workforce, which I wrote in 2013. I am grateful to Broadspire and Concentra for their support on this project.


Peter Rousmaniere

Peter Rousmaniere is widely known throughout the workers’ compensation industry, both for his writing and consulting experience. Based in the picture perfect New England town of Woodstock, VT, he is a regular on the conference circuit, and is deeply in tune with trends and developments within the industry. His passion is writing and presenting on issues largely related to immigration, and he maintains a blog on the subject at