Raul Rosas lies in pain in a dark, foul-smelling hovel that resembles a shallow cave more than a basement.

Paralyzed in a workplace accident five years ago, he survives by selling fruits and vegetables from a wheelchair on a Chicago street corner. But now he is sick with a stomach infection and can't buy medication because he has no way to get to a drugstore

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Since losing the ability to walk, Rosas' life has shrunk to the barest existence. He is a veritable ghost, and a depleted one because he is an illegal immigrant and therefore ineligible for all government assistance beyond emergency room care.

"It is very hard," he said dejectedly, turning his crumpled body away.

When an undocumented worker has an accident or gets sick, it puts pressure on the families, who must do without a paycheck, and it puts pressure on the public health system, because the workers are less likely to have insurance.

This is an issue at the heart of the debate over immigration reform: whether the economic contributions of illegal workers outweigh the costs, and whether they should remain in the U.S. at all.

What's been overlooked are the risks the workers take, the price they pay and the impact.

Because they tend to exist in the shadows, beyond the workplace protections that others take for granted, the undocumented are more likely to face hardships after their accidents. Some return home. Others remain in the United States, partly because they still can earn more income here.

Rosas, an immigrant from Mexico, was hired to remove a tree from a back yard. The tree fell and seriously injured him.

"The guy he was working for didn't even want to call the ambulance," said Ramon Canellada, a disability coordinator at Schwab Rehabilitation Hospital on Chicago's South Side, where Rosas was briefly treated.

Since then, Rosas has not received any government-supported therapy, or any medicine or a wheelchair. He bought those himself. One of his few protectors is Canellada, who has tried to keep an eye on him, even scrounging for parts for Rosas' electric wheelchair.

Fiercely independent, Rosas, 48, lives on whatever he earns from fruit-and-vegetable sales during warm-weather days. He pays $300 a month for his tiny corner of the basement, which he shares with two other Latino workers.

Before the recent uproar over illegal immigrants, Rene Lune, a worker with Access Living, a Chicago agency that helps the disabled, would refer injured Latino workers such as Rosas to public health agencies, which might overlook their immigration status and provide help.

"Now with all of the strict background checks, [agencies] won't do it," Lune said.

The worker's compensation system is supposed to help injured workers such as Rosas with recovery--and that includes illegal immigrants. Nearly every employer in Illinois is required to provide such coverage.

But because of the risky or marginal jobs held by illegal workers and the types of employers they work for, the system hasn't exactly benefited Latino workers.

Many are injured while working for small businesses that have neither health insurance nor worker's compensation coverage, said attorney Jose Rivero. Some larger companies, he added, don't think they have to provide benefits for their "clandestine" workforce.

Illinois overseers shut down

For years the state did little to make sure employers complied with the state's worker's compensation law. From 1983 to 1996, the Illinois Workers Compensation Commission kept shut its compliance unit for budgetary reasons, according to state officials. It now has four workers, none of whom speaks Spanish.

Asked how many employers comply with the law, state officials, replying by e-mail, said they didn't know but were looking for ways to find that out.

Rivero is hopeful that the commission will do a better job because of laws passed last year. Those laws beef up the penalties and give the commission more power to go after businesses that do not provide worker's compensation.

The changes came from a state commission last year that looked at Latino workers' injuries and fatalities. It was the only state-sponsored study of its kind, Illinois officials point out.

Still, even when the law is upheld, there are problems.

Rather than pay hefty medical bills, firms without insurance will threaten to go out of business, which is one reason Rivero often said he seeks lower settlements for his clients.

The presence of so many Latinos in low-wage jobs also pushes him toward reduced-compensation settlements. It is hard to bargain for hefty settlements when they earn so little. A missing finger or a burn that will linger for a lifetime winds up discounted for the low-wage Latino worker.

Yolanda Sanchez, 55, understands that.

A part-time weekend cook at a small restaurant in Chicago, she suffered a bad burn from a tipped vat of hot cooking oil. She earned $80 weekly from the restaurant and had two other jobs in order to get by.

The restaurant didn't have worker's compensation insurance, so Rivero settled for $12,000; Sanchez got $8,000. She had a $14,000 unpaid bill with Stroger Hospital, but it was willing to accept $4,000, Rivero said.

"I was concerned about not getting anything," he said.

Indeed, workers' unpaid medical bills is a significant issue.

"We have had a number of clients who had really bad injuries and literally hundreds of thousands of dollars that hospitals have had to eat because there was no health insurance," lawyer David Menchetti said.

The overall bill for treating injured immigrants without insurance is not known, but the federal government acknowledged the problem's depth in 2005 when it began setting aside $250 million a year to cover emergency medical-care costs for illegal immigrants shouldered by communities across the U.S.

A share of those bills comes from workers hurt on the job, such as Oscar Gaytan, 23.

Gaytan was working at the St. Anne Area Farmer Auction near Kankakee in March 2003 when he was told to change a light bulb from a fake ceiling. He had been employed there about nine months, he said, earning $6 an hour. Tall and husky, he had come from Mexico three years earlier.

He fell about 30 feet, hitting his head on the blades of a large piece of farm equipment. He spent about 30 days in a hospital. His medical bills, according to a July 2004 ruling by an Illinois Workers' Compensation Commission arbitrator, came to $270,541. The commission also ordered the small farm-equipment auction to pay Gaytan $135,270 for his injuries and his lawyers $27,054 for their work.

Gaytan hasn't received a penny. Nor have any of those who provided medical care. Auction owner James Wituoet said only that he is appealing the case.

"I am not the same as before," Gaytan said after work recently at a farm near Kankakee. He is constantly reminded of the accident by headaches and by a scar across the back of his skull. He fears crowds and the dark, and he rarely goes out.

He remembers a doctor telling him that he needs therapy, but he has not received any since the accident because he cannot pay for it and he is ineligible for government support.

Much of the responsibility for protecting the nation's workers rests with the U.S. Occupational Safety and Health Administration. OSHA officials in Washington and Chicago boast about hiring more Spanish-speaking OSHA workers, about making partners with Latino community groups and about winning over Latino workers' trust.

But they also concede it is a struggle.

To begin, the agency's ranks are limited, they say. Then there is the wave of fear that swept Latino communities last year after Homeland Security officials, posing as OSHA representatives, called a "mandatory" safety workshop in North Carolina and arrested the workers who showed up. OSHA officials say that was a wrong thing to do and won't happen again.

There also is the broad reluctance of workers and others to identify dangerous workplaces.

"It is better. People know who we are," said Michael Connors, OSHA's regional head in Chicago. "But it is not like we are getting any calls or complaints from the community."

Nor, Connors said, do physicians alert his agency.

Jose Oliva of the Chicago-based Interfaith Committee on Worker Issues, an advocacy group, said it has a unique arrangement with OSHA that allows it to relay workers' anonymous complaints. It was the first of its kind in the nation, and OSHA officials hailed it as a way to reach workers.

Backdoor for whistle-blowers

But sometimes Oliva is reluctant to name companies.

"It is hard for us," he said. "You know you are putting people back into danger. [But] if the company went out of business, you would have 300 people out of jobs."

Not long ago he decided not to file a complaint with OSHA against a Bellwood company after it agreed to hire back about 25 Latinos who had been let go because they took time off to march in an immigration rally. Some workers had complained that the firm did not provide safety equipment and that fans failed to ventilate toxic fumes, Oliva said.

A month after the company rehired the workers, an explosion there killed a truck driver making a delivery and injured three factory workers and two firefighters. OSHA officials said they are investigating the incident at Universal Farm Clamp Co.

Company officials declined to comment.

Ivan Caudillo's death in March last year is a reminder that OSHA can do only so much when someone dies on the job.

Caudillo, a 21-year-old illegal Mexican immigrant, had been on the job four days at Euro Marble & Granite Inc. in suburban Schiller Park and had handled large chunks of material the day before when he was crushed by 3 tons of granite.

Until then, he had worked part-time as a dishwasher and bus boy while going to school. He had been sending money home to his family in Mexico.

But because he planned to marry, he had sought the better-paying job so he could send more money to his fiance, according to his uncle, Alvaro Caudillo, with whom he had lived.

Ivan Caudillo and two other workers were attempting to load sheets of granite stored in a trailer, according to Schiller Park police and OSHA reports.

The strap holding the marble to a lifting device apparently was loose, and Caudillo stepped into the trailer to steady it. The granite shifted and fell on him.

"The fact that he went back in to try to catch the granite would reflect that he didn't [understand] what was going on," said attorney James Geraghty, who looked into the case at the uncle's request. "It's training. The majority of these situations are training-related. It is not that they are unskilled; it is that they are untrained."

OSHA officials looked into that question and decided the company had told Caudillo about the job the day before. "Hands-on training" is enough, OSHA's Connors said.

OSHA initially fined the company $11,250 for a series of violations but reduced it to $3,800, which Connors said is not unusual. The company threatened to take the case to court, and the agency prefers to avoid such battles--one reason that such fines often are reduced.

The firm also got a break because it is a small business, Connors said. OSHA later fined the company $3,887 for other violations and reduced that to $2,720.

Company lawyer Charles Harth said the violations were not related to the death, but he declined to comment further.

Of all the Illinois workplace death inspections by OSHA that were closed from 2000 to 2004, no violations were filed in 41 percent of the cases.

Similarly, of the cases where violations were found, half of the inspections resulted in a fine of $3,125 or less.

Upset by his nephew's death, Alvaro Caudillo threw himself into the case, hoping to gain some money for the family through the courts.

A lawyer helped him get the company's insurer to pay for sending his nephew's body to Mexico, but that was it. Caudillo tried, but no other lawyers were interested in the worker's compensation case.

Because Ivan Caudillo was unmarried and had stopped sending money to his family, it became a complicated case, they said.

But not to Caudillo, who has kept his nephew's records in order, everything filed and folded carefully.

In one plastic folder, he has the money he recently received from the company for his nephew's sole check, $214.80. He said he will send it soon to his brother.

Caudillo recently felt ill, but his doctor told him there is nothing wrong with him.

"I'm probably too worried about this," said Caudillo, a tailor who walks with a stiff gait--the result of aging, he said.

"I feel the pain of his death," he said, leaning back as if there were a weight pressing down on his chest. "It is indescribable."