The passage of mandatory seat belt legislation has markedly decreased the incidence of head and neck trauma to passengers in private automobiles. However, taxicabs are exempt from seat belt laws in many states. Seat belts, which are included as standard equipment by automobile manufacturers, are often made inaccessible by taxicab operators. We present five cases of head and neck trauma sustained by passengers in taxicabs in which seat belts were not accessible. Injuries included laryngeal fractures, maxillofacial trauma, and severe trauma to the cervical spine. All injuries could have been avoided by the use of an accessible safety belt. The nationwide scope of this problem and strategies for modification of existing laws for better protection of passengers in cars for hire are presented.