Step 2 - Complete all the information below and click on the "Submit Request" button at the end of the form.
Facts You Should Know
As you may know, the Black Car Fund provides drivers in the black car industry with workers’ compensation benefits. In order to help its covered drivers stay healthy and reduce accidents that lead to injuries the Black Car Fund is sponsoring this Program for the purposes of injury and medical claims reduction. The Program is provided to you as a driver covered by the Black Car Fund and is not intended to provide you with any rights of employment or to otherwise affect your status as an independent contractor with respect to the Black Car Fund or with the dispatch base you are affiliated with. While we hope you will participate in the Program, the Program is entirely voluntary and you are not required to participate. If you are an employee driver, this Program is not sponsored or endorsed by your employer. The Program is not intended to be covered by the Employee Retirement Income Security Act (ERISA) or the Patient Protection and Affordable Care Act (“PPACA”). If you register for the telemedicine benefits available under the Program, you may become ineligible to contribute to a health savings account. Consult with your tax advisor for more information. The Black Car Fund reserves the right to revise or terminate this Program in whole or in part at any time, and for any reason..