The incident happened at one of the busiest times of the day at one of the busiest intersections in downtown Los Angeles.
The skyscraper is the tallest on the West Coast once it is completed.
The electrician worker, who was on his second day of the project, fell from the 53rd floor of the Wilshire Grand Center at around noon on Thursday on to the back edge of a passing car.
Its driver did not appear to be seriously hurt but was taken to a hospital.
Lisa Gritzner, a spokeswoman for Turner Construction, said the worker was not supposed to be above the third floor of the building and had removed his hardhat before he fell.
She said the man was not wearing a safety harness, and had not been issued with one because his work did not require it.
The $1bn, 73-storey skyscraper will be about 1,100ft tall (335 metres) when it is finished next year.
Chris Martin, CEO of Martin Project Management which is supervising the construction, said there were barricades around the edge of the building and other safety measures in place.
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