§ 5103 — Entitlement to first party benefits; additional financial security required

New York § 5103

• Jurisdiction: New York
• Law ISC: Insurance
• Art. 51: Comprehensive Motor Vehicle Insurance Reparations

Text

§ 5103. Entitlement to first party benefits; additional financial\nsecurity required. (a) Every owner's policy of liability insurance\nissued on a motor vehicle in satisfaction of the requirements of article\nsix or eight of the vehicle and traffic law shall also provide for;\nevery owner who maintains another form of financial security on a motor\nvehicle in satisfaction of the requirements of such articles shall be\nliable for; and every owner of a motor vehicle required to be subject to\nthe provisions of this article by subdivision two of section three\nhundred twenty-one of the vehicle and traffic law shall be liable for;\nthe payment of first party benefits to:\n (1) Persons, other than occupants of another motor vehicle or a\nmotorcycle, for loss arising out of the use or operation in this state\nof such motor vehicle. In the case of occupants of a bus other than\noperators, owners, and employees of the owner or operator of the bus,\nthe coverage for first party benefits shall be afforded under the policy\nor policies, if any, providing first party benefits to the injured\nperson and members of his household for loss arising out of the use or\noperation of any motor vehicle of such household. In the event there is\nno such policy, first party benefits shall be provided by the insurer of\nsuch bus.\n (2) The named insured and members of his household, other than\noccupants of a motorcycle, for loss arising out of the use or operation\nof (i) an uninsured motor vehicle or motorcycle, within the United\nStates, its territories or possessions, or Canada; and (ii) an insured\nmotor vehicle or motorcycle outside of this state and within the United\nStates, its territories or possessions, or Canada.\n (3) Any New York resident who is neither the owner of a motor vehicle\nwith respect to which coverage for first party benefits is required by\nthis article nor, as a member of a household, is entitled to first party\nbenefits under paragraph two of this subsection, for loss arising out of\nthe use or operation of the insured or self-insured motor vehicle\noutside of this state and within the United States, its territories or\npossessions, or Canada.\n (4) The estate of any covered person, other than an occupant of\nanother motor vehicle or a motorcycle, a death benefit in the amount of\ntwo thousand dollars for the death of such person arising out of the use\nor operation of such motor vehicle which is in addition to any first\nparty benefits for basic economic loss.\n (b) An insurer may exclude from coverage required by subsection (a)\nhereof a person who:\n (1) Intentionally causes his own injury.\n (2) Is injured as a result of operating a motor vehicle while in an\nintoxicated condition or while his ability to operate such vehicle is\nimpaired by the use of a drug within the meaning of section eleven\nhundred ninety-two of the vehicle and traffic law; provided, however,\nthat an insurer shall not exclude such person from coverage with respect\nto necessary emergency health services rendered in a general hospital,\nas defined in subdivision ten of section two thousand eight hundred one\nof the public health law, including ambulance services attendant thereto\nand related medical screening. Notwithstanding any other law, where the\ncovered person is found to have violated section eleven hundred\nninety-two of the vehicle and traffic law, the insurer has a cause of\naction for the amount of first party benefits paid or payable on behalf\nof such covered person against such covered person.\n (3) Is injured while he is: (i) committing an act which would\nconstitute a felony, or seeking to avoid lawful apprehension or arrest\nby a law enforcement officer, or (ii) operating a motor vehicle in a\nrace or speed test, or (iii) operating or occupying a motor vehicle\nknown to him to be stolen, or (iv) operating or occupying any motor\nvehicle owned by such injured person with respect to which the coverage\nrequired by subsection (a) hereof is not in effect, or (v) a pedestrian,\nthrough being struck by any motor vehicle owned by such injured\npedestrian with respect to which the coverage required by subsection (a)\nhereof is not in effect, or (vi) repairing, servicing or otherwise\nmaintaining a motor vehicle if such conduct is within the course of a\nbusiness of repairing, servicing or otherwise maintaining a motor\nvehicle and the injury occurs on the business premises.\n (4) Is injured while a motor vehicle is being used or operated by a\nTNC driver pursuant to article forty-four-B of the vehicle and traffic\nlaw, provided, however, that only the insurer issuing the owner's policy\nof liability insurance providing coverage for the motor vehicle being\noperated by a TNC driver may exclude such coverage and an insurer may\nnot include this exclusion in a policy used to satisfy the requirements\nunder article forty-four-B of the vehicle and traffic law.\n 5. Is injured while a motor vehicle is being used or operated by a\nshared vehicle driver pursuant to article forty of the general business\nlaw, provided, however, that only the insurer issuing the owner's policy\nof liability insurance providing coverage for the motor vehicle being\nused or operated by a shared vehicle driver may exclude such coverage\nand an insurer may not include this exclusion in a policy used to\nsatisfy the requirements of article forty of the general business law.\n (c) Insurance offered by any company to satisfy the requirements of\nsubsection (a) hereof shall be offered (i) without a deductible and (ii)\nwith a family deductible of up to two hundred dollars (which deductible\nshall apply only to the loss of the named insured and members of his\nhousehold). The superintendent may approve a higher deductible in the\ncase of insurance policies providing additional benefits or pursuant to\na plan designed and implemented to coordinate first party benefits with\nother benefits.\n (d) Insurance policy forms for insurance to satisfy the requirements\nof subsection (a) hereof shall be subject to approval pursuant to\narticle twenty-three of this chapter. Minimum benefit standards for such\npolicies and for self-insurers, and rights of subrogation, examination\nand other such matters, shall be established by regulation pursuant to\nsection three hundred one of this chapter.\n (e) Every owner's policy of liability insurance issued in satisfaction\nof article six or eight of the vehicle and traffic law shall also\nprovide, when a motor vehicle covered by such policy is used or operated\nin any other state or in any Canadian province, insurance coverage for\nsuch motor vehicle at least in the minimum amount required by the laws\nof that state or province.\n (f) Every owner's policy of liability insurance issued on a motorcycle\nor an all terrain vehicle in satisfaction of the requirements of article\nsix or eight of the vehicle and traffic law or section twenty-four\nhundred seven of such law shall also provide for; every owner who\nmaintains another form of financial security on a motorcycle or an all\nterrain vehicle in satisfaction of the requirements of such articles or\nsection shall be liable for; and every owner of a motorcycle or an all\nterrain vehicle required to be subject to the provisions of this article\nby subdivision two of section three hundred twenty-one of such law shall\nbe liable for; the payment of first party benefits to persons, other\nthan the occupants of such motorcycle or all terrain vehicle, another\nmotorcycle or all terrain vehicle, or any motor vehicle, for loss\narising out of the use or operation of the motorcycle or all terrain\nvehicle within this state. Every insurer and self-insurer may exclude\nfrom the coverage required by this subsection a person who intentionally\ncauses his own injury or is injured while committing an act which would\nconstitute a felony or while seeking to avoid lawful apprehension or\narrest by a law enforcement officer.\n (g) A company authorized to provide the insurance specified in\nparagraph three of subsection (a) of section one thousand one hundred\nthirteen of this chapter or a corporation organized pursuant to article\nforty-three of this chapter may, individually or jointly, with the\napproval of the superintendent upon a showing that the company or\ncorporation is qualified to provide for all of the items of basic\neconomic loss specified in paragraph one of subsection (a) of section\nfive thousand one hundred two of this article, provide coverage for such\nitems of basic economic loss to the extent that an insurer would be\nrequired to provide under this article. Where a policyholder elects to\nbe covered under such an arrangement the insurer providing coverage for\nthe automobile shall be furnished with the names of all persons covered\nby the company or corporation under the arrangement and such persons\nshall not be entitled to benefits for any of the items of basic economic\nloss specified in such paragraph. The premium for the automobile\ninsurance policy shall be appropriately reduced to reflect the\nelimination of coverage for such items of basic economic loss. Coverage\nby the automobile insurer of such eliminated items shall be effected or\nrestored upon request by the insured and payment of the premium for such\ncoverage. All companies and corporations providing coverage for items of\nbasic economic loss pursuant to the authorization of this subsection\nshall have only those rights and obligations which are applicable to an\ninsurer subject to this article.\n (h) Any policy of insurance obtained to satisfy the financial security\nrequirements of article six or eight of the vehicle and traffic law\nwhich does not contain provisions complying with the requirements of\nthis article, shall be construed as if such provisions were embodied\ntherein.\n