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Motorcycle Insurance Laws

New York State Motorcycle Insurance Laws

Subpart 65-1  Prescribed Policy Endorsements
Subpart 65-2  Rights and Liabilities of Self-insurers
Subpart 65-3  Claims for Personal Injury Protection benefits
Subpart 65-4  Arbitration


NEW YORK STATE - INSURANCE DEPARTMENT
REGULATION NO. 68  - (11 NYCRR 65)


REGULATIONS IMPLEMENTING THE COMPREHENSIVE MOTOR VEHICLE INSURANCE REPARATIONS ACT

11 NYCRR 65-1 - (Regulation 68-A)

Prescribed Policy Endorsements

 

65-1.1  Requirements for minimum benefit insurance policies for personal injuries

 

(a) Every owner’s policy of liability insurance issued in satisfaction of the minimum requirements of article 6 or 8 of the Vehicle and Traffic Law and article 51 of the Insurance Law shall contain provisions providing minimum first-party benefits equal to those set out below in the mandatory personal injury protection endorsement (New York), or mandatory personal injury protection endorsement - motorcycles (New York), respectively. 

 

(b) The Mandatory Personal Injury Protection Endorsement (New York) and the Mandatory Personal Injury Protection Endorsement - Motorcycles (New York) set out below are approved and promulgated for use by an insurer and, except as provided in subdivision (c) of this section and section 65-1.7 of this Subpart, must be:

 

(1) furnished to all new insureds with policies effective on and after September 1, 2001; and 

 

(2) enclosed with the first renewal policies renewed on and after September 1, 2001.

 

(c) The Mandatory Personal Injury Protection Endorsement - All-Terrain Vehicles (New York), set out below is approved and promulgated for use by an insurer and, except as provided in section 65-1.7 of this Subpart, must be issued with every liability policy covering an All-Terrain Vehicle as required by section 2407 of article 48-C of the New York Vehicle and Traffic Law and Subpart 64-2 of this Title and must be:

 

(1) furnished to all new insureds with policies effective on and after September 1, 2001; and 

 

(2) enclosed with the first renewal policies renewed on and after September 1, 2001.

 

 

(d) Mandatory Personal Injury Protection Endorsement

 

 

MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT

(New York)

 

The Company agrees with the named insured, as follows: 

 

Section I

Mandatory Personal Injury Protection

 

The company will pay first-party benefits to reimburse for basic economic loss sustained by an eligible injured person on account of personal injuries caused by an accident arising out of the use or operation of a motor vehicle or a motorcycle during the policy period and within the United States of America, its territories or possessions, or Canada.

 

First-party Benefits

 

First-party benefits, other than death benefits, are payments equal to basic economic loss, reduced by the following:

 

(a) 20 percent of the eligible injured person’s loss of earnings from work to the extent that an eligible injured person’s basic economic loss consists of such loss of earnings;

 

(b) amounts recovered or recoverable on account of personal injury to an eligible injured person under State or Federal laws providing social security disability or workers’ compensation benefits, or disability benefits under article 9 of the New York Workers’ Compensation Law;

 

(c) the amount of any applicable deductible, provided that such deductible shall apply to each accident, but only to the total of first-party benefits otherwise payable to the named insured and any relative as a result of that accident.

 

Basic Economic Loss

 

Basic economic loss shall consist of medical expense, work loss, other expense and, when death occurs, a death benefit as herein provided. Except for such death benefit, basic economic loss shall not include any loss sustained on account of death. Basic economic loss of each eligible injured person on account of any single accident shall not exceed $50,000, except that any death benefit hereunder shall be in addition thereto. 

 

Medical Expense

 

Medical expense shall consist of necessary expenses for: 

 

(a) medical, hospital (including services rendered in compliance with Article 41 of the Public Health Law, whether or not such services are rendered directly by a hospital), surgical, nursing, dental, ambulance, X-ray, prescription drug and prosthetic services;

 

(b) psychiatric, physical and occupational therapy and rehabilitation;

 

(c) any nonmedical remedial care and treatment rendered in accordance with a religious method of healing recognized by the laws of New York; and

 

(d) any other professional health services.

 

These medical expenses will not be subject to a time limitation, provided that, within one year after the date of the accident, it is ascertainable that further medical expenses may be sustained as a result of the injury. Payments hereunder for necessary medical expenses shall be subject to the limitations and requirements of section 5108 of the New York Insurance Law.

 

Work Loss

 

Work loss shall consist of the sum of the following losses and expenses, up to a maximum payment of $2,000 per month for a maximum period of three years from the date of the accident: 

 

(a) loss of earnings from work which the eligible injured person would have performed had such person not been injured, except that an employee who is entitled to receive monetary payments, pursuant to statute or contract with the employer, or who receives voluntary monetary benefits paid for by the employer, by reason of such employee’s inability to work because of personal injury arising out of the use or operation of a motor vehicle or a motorcycle, shall not be entitled to receive first-party benefits for loss of earnings from work to the extent that such monetary payments or benefits from the employer do not result in the employee suffering a reduction in income or a reduction in such employee’s level of future benefits arising from a subsequent illness or injury; and

 

(b) reasonable and necessary expenses sustained by the eligible injured person in obtaining services in lieu of those which such person would have performed for income.

 

Other Expenses

 

Other expenses shall consist of all reasonable and necessary expenses, other than medical expense and work loss, up to $25 per day for a period of one year from the date of the accident causing injury.

 

Death Benefit

 

Upon the death of any eligible injured person, caused by an accident to which this coverage applies, the company will pay to the estate of such person a death benefit of $2,000.

 

Eligible Injured Person

 

Subject to the exclusions and conditions set forth below, an eligible injured person is: 

 

(a) the named insured and any relative who sustains personal injury arising out of the use or operation of any motor vehicle;

 

(b) the named insured and any relative who sustains personal injury arising out of the use or operation of any motorcycle, while not occupying a motorcycle;

 

(c) any other person who sustains personal injury arising out of the use or operation of the insured motor vehicle in the State of New York while not occupying another motor vehicle; or

 

(d) any New York State resident who sustains personal injury arising out of the use or operation of the insured motor vehicle outside of New York while not occupying another motor vehicle.

 

Exclusions

 

This coverage does not apply to personal injury sustained by: 

 

(a) the named insured while occupying, or while a pedestrian through being struck by, any motor vehicle owned by the named insured with respect to which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is not in effect; 

 

(b) any relative while occupying, or while a pedestrian through being struck by, any motor vehicle owned by the relative with respect to which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is not in effect;

 

(c) the named insured or relative while occupying, or while a pedestrian through being struck by, a motor vehicle in New York State, other than the insured motor vehicle, with respect to which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is in effect; however, this exclusion does not apply to personal injury sustained in New York State by the named insured or relative while occupying a bus or school bus, as defined in sections 104 and 142 of the New York Vehicle and Traffic Law, unless that person is the operator, an owner, or an employee of the owner or operator, of such bus or school bus;

 

[(d) any person in New York State while occupying the insured motor vehicle which is a bus or school bus, as defined in sections 104 and 142 of the New York Vehicle and Traffic Law, but only if such person is a named insured or relative under any other policy providing the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act; however, this exclusion does not apply to the operator, an owner, or an employee of the owner or operator, of such bus or school bus;]1

 

(e) any person while occupying a motorcycle;

 

(f) any person who intentionally causes his or her own personal injury2;

 

(g) any person as a result of operating a motor vehicle while in an intoxicated condition or while his ability to operate such vehicle is impaired by the use of a drug (within the meaning of section 1192 of the New York Vehicle and Traffic Law); 2 or

 

(h) any person while:

 

(1) committing an act which would constitute a felony, or seeking to avoid lawful apprehension or arrest by a law enforcement officer;2

 

(2) operating a motor vehicle in a race or speed test;2

 

1Language in brackets may be deleted if the insured motor vehicle is not a bus or school bus.

2These exclusions may be deleted, in the event the Company wishes to provide coverage under the indicated circumstances.

(3) operating or occupying a motor vehicle known to that person to be stolen;2 or

 

(4) repairing, servicing or otherwise maintaining a motor vehicle if such conduct is within the course of a business of repairing, servicing or otherwise maintaining a motor vehicle and the injury occurs on the business premises; 3

 

(i) the named insured or relative while not occupying a motor vehicle or a motorcycle when struck by a motorcycle in New York State with respect to which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is in effect;

 

(j) any New York State resident other than the named insured or relative injured through the use or operation of the insured motor vehicle outside of New York State if such resident is the owner or a relative of the owner of a motor vehicle insured under another policy providing the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act;

 

(k) any New York State resident other than the named insured or relative injured through the use or operation of the insured motor vehicle outside of New York State if such resident is the owner of a motor vehicle for which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is not in effect. 

 

Other Definitions 

 

When used in reference to this coverage: 

 

(a) the “insured motor vehicle” means a motor vehicle owned by the named insured and to which the bodily injury liability insurance of this policy applies and for which a specific premium is charged; 

 

(b) “motorcycle” means a vehicle as defined in section 123 of the New York Vehicle and Traffic Law and which is required to carry financial security pursuant to article 6, 8 or 48-A of the Vehicle and Traffic Law;

 

(c) “motor vehicle” means a motor vehicle, as defined in section 311 of the New York Vehicle and Traffic Law, and also includes fire and police vehicles, but shall not include any motor vehicle not required to carry financial security pursuant to article 6, 8 or 48-A of the Vehicle and Traffic Law, or a motorcycle as defined above;

 

3These exclusions may be deleted, in the event the Company wishes to provide coverage under the indicated circumstances.

 

(d) “named insured” means the person or organization named [in the declarations];4

 

(e) “occupying” means in or upon or entering into or alighting from; 

 

(f) “personal injury” means bodily injury, sickness or disease;

 

(g) “relative” means a spouse, child, or other person related to the named insured by blood, marriage, or adoption (including a ward or foster child), who regularly resides in the insured’s household, including any such person who regularly resides in the household, but is temporarily living elsewhere; and

 

(h) “use or operation” of a motor vehicle or a motorcycle includes the loading or unloading of such vehicle.

 

Conditions

 

Action Against Company.  No action shall lie against the Company unless, as a condition precedent thereto, there shall have been full compliance with the terms of this coverage. 

 

Notice.  In the event of an accident, written notice setting forth details sufficient to identify the eligible injured person, along with reasonably obtainable information regarding the time, place and circumstances of the accident, shall be given by, or on behalf of, each eligible injured person, to the Company, or any of the Company’s authorized agents, as soon as reasonably practicable, but in no event more than 30 days after the date of the accident, unless the eligible injured person submits written proof providing clear and reasonable justification for the failure to comply with such time limitation. If an eligible injured person or that person’s legal representative institutes a proceeding to recover damages for personal injury under section 5104(b) of the New York Insurance Law, a copy of the summons and complaint or other process served in connection with such action shall be forwarded as soon as practicable to the Company or any of the Company’s authorized agents by such eligible injured person or that person’s legal representative. 

 

Proof of Claim;  Medical, Work Loss, and Other Necessary Expenses. In the case of a claim for health service expenses, the eligible injured person or that person’s assignee or representative shall submit written proof of claim to the Company, including full particulars of the nature and extent of the injuries and treatment received and contemplated, as soon as reasonably practicable but, in no event later than 45 days after the date services are rendered.  The eligible injured person or that person’s representative shall submit written proof of claim for work loss benefits and for other necessary expenses to the Company as soon as reasonably practicable but, in no event, later than 90 days after the work loss is incurred or the other necessary services are rendered. The foregoing time limitations for the submission of proof of claim shall apply unless the eligible injured person or that person’s representative submits written proof providing clear and reasonable justification for the failure to comply with such time limitation. Upon request by the Company, the eligible injured person or that person’s assignee or representative shall:

4Companies may substitute the appropriate term, reference or language for the matter set out in brackets.

 

(a) execute a written proof of claim under oath;

 

(b) as may reasonably be required submit to examinations under oath by any person named by the Company and subscribe the same;

 

(c) provide authorization that will enable the Company to obtain medical records; and

 

(d) provide any other pertinent information that may assist the Company in determining the amount due and payable. 

 

The eligible injured person shall submit to medical examination by physicians selected by, or acceptable to, the Company, when, and as often as, the Company may reasonably require. 

 

Arbitration.  In the event any person making a claim for first-party benefits and the Company do not agree regarding any matter relating to the claim, such person shall have the option of submitting such disagreement to arbitration pursuant to procedures promulgated or approved by the Superintendent of Insurance. 

 

Reimbursement and Trust Agreement.  To the extent that the Company pays first-party benefits, the Company is entitled to the proceeds of any settlement or judgment resulting from the exercise of any right of recovery for damages for personal injury under section 5104(b) of the New York Insurance Law. The Company shall have a lien upon any such settlement or judgment to the extent that the Company has paid first-party benefits. An eligible injured person shall: 

 

(a) hold in trust, for the benefit of the Company, all rights of recovery which that person shall have for personal injury under section 5104(b) of the New York Insurance Law;

 

(b) do whatever is proper to secure, and shall do nothing to prejudice, such rights; and

 

(c) execute, and deliver to the Company, instruments and papers as may be appropriate to secure the rights and obligations of such person and the Company established by this provision.

 

An eligible injured person shall not compromise an action to recover damages brought under section 5104(b) of the New York Insurance Law, except: 

 

(a) with the written consent of the Company;

 

(b) with approval of the court; or

 

(c) where the amount of the settlement exceeds $50,000.

 

Other Coverage.  Where more than one source of first-party benefits required by article 51 of the New York Insurance Law and article 6 or 8 of the New York Vehicle and Traffic Law is available and applicable to an eligible injured person in any one accident, this Company is liable to an eligible injured person only for an amount equal to the maximum amount that the eligible injured person is entitled to recover under this coverage, divided by the number of available and applicable sources of required first-party benefits. An eligible injured person shall not recover duplicate benefits for the same elements of loss under this coverage or any other mandatory first-party motor vehicle or no-fault motor vehicle insurance coverage issued in compliance with the laws of another state. 

 

If the eligible injured person is entitled to benefits under any such mandatory first-party motor vehicle or no-fault motor vehicle insurance for the same elements of loss under this coverage, this Company shall be liable only for an amount equal to the proportion that the total amount available under this coverage bears to the sum of the amount available under this coverage and the amount available under such other mandatory insurance for the common elements of loss. However, where another state’s mandatory first-party or no-fault motor vehicle insurance law provides unlimited coverage available to an eligible injured person for an element of loss under this coverage, the obligation of this Company is to share equally for that element of loss with such other mandatory insurance until the $50,000, or $75,000 if Optional Basic Economic Loss (OBEL) coverage is purchased, limit of this coverage is exhausted by the payment of that element of loss and any other elements of loss. 

 

Section II

Excess Coverage

 

If motor vehicle medical payments coverage or any disability coverages or uninsured motorists coverage are afforded under this policy, such coverages shall be excess insurance over any Mandatory PIP, OBEL or Additional PIP benefits paid or payable, or which would be paid or payable but for the application of a deductible, under this or any other motor vehicle No-Fault insurance policy.

 

Section III

Constitutionality

 

If it is conclusively determined by a court of competent jurisdiction that the New York Comprehensive Motor Vehicle Insurance Reparations Act, or any amendment thereto, is invalid or unenforceable in whole or in part, then, subject to the approval of the Superintendent of Insurance, the Company may amend this policy and may also recompute the premium for the existing or amended policy.

 

These amendments and recomputations will be effective retroactively to the date that such act or any amendment is deemed to be invalid or unenforceable in whole or in part.

 

*    *    *

 

(e)  Mandatory Personal Injury Protection Endorsement - Motorcycles

 

MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT

MOTORCYCLES - (New York) 5

 

The company agrees with the named insured as follows:

 

Section I

Mandatory Personal Injury Protection

 

The Company will pay first-party benefits to reimburse for basic economic loss sustained by an eligible injured person on account of personal injuries caused by an accident arising out of the use or operation of the insured motorcycle. This coverage applies only to motorcycle accidents which occur during the policy period and within the State of New York.

 

Eligible Injured Person

 

An eligible injured person is any person who sustains a personal injury arising out of the use or operation of the insured motorcycle while not occupying the insured motorcycle, any other motorcycle or a motor vehicle.

 

First-party Benefits

 

First-party benefits, other than death benefits, are payments equal to basic economic loss, reduced by the following:

 

(a) 20 percent of the eligible injured person’s loss of earnings from work to the extent that an eligible injured person’s basic economic loss consists of such loss of earnings;

 

(b) amounts recovered or recoverable on account of personal injury to an eligible injured person under State or Federal laws providing social security disability or workers’ compensation benefits, or disability benefits under article 9 of the New York Workers’ Compensation Law.

 

Basic Economic Loss

 

Basic economic loss shall consist of medical expense, work loss, other expense and, when death occurs, a death benefit as herein provided. Except for such death benefit, basic economic loss shall not include any loss sustained on account of death. Basic economic loss of each eligible injured person on account of any single accident shall not exceed $50,000, except that any death benefit hereunder shall be in addition thereto. 

 

5 This endorsement shall be issued only for insured motorcycles.

 

Medical Expense

 

Medical expense shall consist of necessary expenses for: 

 

(a) medical, hospital (including services rendered in compliance with article 41 of the Public Health Law, whether or not such services are rendered directly by a hospital), surgical, nursing, dental, ambulance, X-ray, prescription drug and prosthetic services;

 

(b) psychiatric, physical and occupational therapy and rehabilitation;

 

(c) any nonmedical remedial care and treatment rendered in accordance with a religious method of healing recognized by the laws of New York; and

 

(d) any other professional health services.

 

These medical expenses will not be subject to a time limitation, provided that within one year after the date of the accident it is ascertainable that further medical expenses may be sustained as a result of the injury. Payments hereunder for necessary medical expenses shall be subject to the limitations and requirements of section 5108 of the New York Insurance Law. 

 

Work Loss

 

Work loss shall consist of the sum of the following losses and expenses, up to a maximum payment of $2,000 per month for a maximum period of three years from the date of the accident:

 

(a) loss of earnings from work which the eligible injured person would have performed had such person not been injured, except that an employee who is entitled to receive monetary payments, pursuant to statute or contract with the employer, or who receives voluntary monetary benefits paid for by the employer, by reason of such employee’s inability to work because of personal injury arising out of the use or operation of a motorcycle, shall not be entitled to receive first-party benefits for loss of earnings from work to the extent that such monetary payments or benefits from the employer do not result in the employee suffering a reduction in income or a reduction in such employee’s level of future benefits arising from a subsequent illness or injury; and

 

(b) reasonable and necessary expenses sustained by the eligible injured person in obtaining services in lieu of those which such person would have performed for income.

 

Other Expenses

 

Other expenses shall consist of all reasonable and necessary expenses, other than medical expense and work loss, up to $25 per day for a period of one year from the date of the accident causing injury. 

 

Death Benefit

 

Upon the death of any eligible injured person, caused by an accident to which this coverage applies, the Company will pay to the estate of such person a death benefit of $2,000.

 

Exclusions6

 

This coverage does not apply: 

 

(a) to a personal injury sustained by any person who intentionally causes his own personal injury;

 

(b) to a personal injury sustained by any person while committing an act which would constitute a felony, or seeking to avoid lawful apprehension or arrest by a law enforcement officer; or

 

(c) to a personal injury sustained by a person while repairing, servicing, or otherwise maintaining a motor vehicle or motorcycle, if such conduct is within the course of a business of repairing, servicing, or otherwise maintaining a motor vehicle or motorcycle and the injury occurs on the business premises.

 

Other Definitions 

 

When used in reference to this coverage: 

 

(a) “insured motorcycle” means a motorcycle owned by the named insured and to which the bodily injury liability insurance of this policy applies and for which a specific premium is charged;

 

(b) “motorcycle” means a vehicle as defined in section 123 of the New York Vehicle and Traffic Law, and which is required to carry financial security pursuant to article 6, 8 or 48-A of the Vehicle and Traffic Law;

 

(c) “motor vehicle” means a motor vehicle, as defined in section 311 of the New York Vehicle and Traffic Law, and also includes fire and police vehicles, but shall not include any motor vehicle not required to carry financial security pursuant to article 6, 8 or 48-A of the Vehicle and Traffic Law, or a motorcycle as defined above;

 

(d) “named insured” means the person or organization named [in the declaration];7

 

(e) “occupying” means in or upon or entering into or alighting from;

 

(f) “personal injury” means bodily injury, sickness or disease;

 

(g) “use or operation” of a motor vehicle or motorcycle includes the loading or unloading of such vehicle.

 

6These exclusions may be deleted, in the event the Company wishes to provide coverage under the indicated circumstances.

 

Conditions

 

Action Against Company.  No action shall lie against the Company unless, as a condition precedent thereto, there shall have been full compliance with the terms of this coverage.

 

Notice.  In the event of an accident, written notice setting forth details sufficient to identify the eligible injured person, along with reasonably obtainable information regarding the time, place and circumstances of the accident, shall be given by, or on behalf of, each eligible injured person, to the Company, or any of the Company’s authorized agents, as soon as reasonably practicable, but in no event more than 30 days after the date of the accident, unless the eligible injured person submits written proof providing clear and reasonable justification for the failure to comply with such time limitation. If an eligible injured person or that person’s legal representative institutes a proceeding to recover damages for personal injury under section 5104(b) of the New York Insurance Law, a copy of the summons and complaint or other process served in connection with such action shall be forwarded as soon as practicable to the Company or any of the Company’s authorized agents by such eligible injured person or that person’s legal representative. 

 

Proof of Claim;  Medical, Work Loss, and Other Necessary Expenses. In the case of a claim for health service expenses, the eligible injured person or that person’s assignee or representative shall submit written proof of claim to the Company, including full particulars of the nature and extent of the injuries and treatment received and contemplated, as soon as reasonably practicable but, in no event later than 45 days after the date services are rendered.  The eligible injured person or that person’s representative shall submit written proof of claim for work loss benefits and for other necessary expenses to the Company as soon as reasonably practicable but, in no event, later than 90 days after the work loss is incurred or the other necessary services are rendered. The foregoing time limitations for the submission of proof of claim shall apply unless the eligible injured person submits written proof providing clear and reasonable justification for the failure to comply with such time limitation. Upon request by the Company, the eligible injured person or that person’s assignee or representative shall:

 

(a) execute a written proof of claim under oath;

 

(b) as may reasonably be required submit to examinations under oath by any person named by the Company and subscribe the same;

 

(c) provide authorization that will enable the Company to obtain medical records; and

(d) provide any other pertinent information that may assist the Company in determining the amount due and payable.

 

7Companies may substitute the appropriate term, reference or language for the matter set out in brackets.

 

The eligible injured person shall submit to medical examination by physicians selected by, or acceptable to, the Company when, and as often as, the Company may reasonably require. 

 

Arbitration.  In the event any person making a claim for first-party benefits and the Company do not agree regarding any matter relating to the claim, such person shall have the option of submitting such disagreement to arbitration pursuant to procedures promulgated or approved by the Superintendent of Insurance.

 

Reimbursement and Trust Agreement.  To the extent that the Company pays first-party benefits, the Company is entitled to the proceeds of any settlement or judgment resulting from the exercise of any right of recovery for damages for personal injury under section 5104(b) of the New York Insurance Law. The Company shall have a lien upon any such settlement or judgment to the extent that the Company has paid first-party benefits. An eligible injured person shall: 

 

(a) hold in trust, for the benefit of the Company, all rights of recovery which that person shall have for personal injury under section 5104(b) of the New York Insurance Law;

 

(b) do whatever is proper to secure, and shall do nothing to prejudice, such rights; and

 

(c) execute, and deliver to the Company, instruments and papers as may be appropriate to secure the rights and obligations of such person and the Company established by this provision.

 

An eligible injured person shall not compromise an action to recover damages brought under section 5104(b) of the New York Insurance Law, except: 

 

(a) with the written consent of the Company;

 

(b) with approval of the court; or

 

(c) where the amount of the settlement exceeds $50,000.

 

Other Coverage.  Where more than one source of first-party benefits required by article 51 of the New York Insurance Law and article 6 or 8 of the New York Vehicle and Traffic Law is available and applicable to an eligible injured person in any one accident, this Company is liable to an eligible injured person only for an amount equal to the maximum amount that the eligible injured person is entitled to recover under this coverage, divided by the number of available and applicable sources of required first-party benefits. An eligible injured person shall not recover duplicate benefits for the same elements of loss under this coverage or any other mandatory first-party motor vehicle or no-fault motor vehicle insurance coverage issued in compliance with the laws of another state.

 

If the eligible injured person is entitled to benefits under any such mandatory first-party motor vehicle or no-fault motor vehicle  insurance for the same elements of loss under this coverage, this Company shall be liable only for an amount equal to the proportion that the total amount available under this coverage bears to the sum of the amount available under this coverage and the amount available under such other mandatory insurance for the common elements of loss. However, where another state’s mandatory first-party or no-fault motor vehicle insurance law provides unlimited coverage available to an eligible injured person for an element of loss under this coverage, the obligation of this Company is to share equally for that element of loss with such other mandatory insurance until the $50,000, or $75,000 if Optional Basic Economic Loss (OBEL) coverage is purchased, limit of this coverage is exhausted by the payment of that element of loss and any other elements of loss. 

 

Section II

Excess Coverage 

 

If medical payments coverage or any disability coverages or uninsured motorists coverage are afforded under this policy, such coverages shall be excess insurance over any Mandatory PIP, OBEL or Additional PIP benefits paid or payable, or which would be paid or payable but for the application of a deductible under this or any other motor vehicle No-Fault insurance policy.

 

Section III

Constitutionality

 

If it is conclusively determined by a court of competent jurisdiction that the New York Comprehensive Motor Vehicle Insurance Reparations Act, or any amendment thereto, is invalid or unenforceable in whole or in part, then, subject to the approval of the Superintendent of Insurance, the Company may amend this policy and may also recompute the premium for the existing or amended policy. 

 

These amendments and recomputations will be effective retroactively to the date that such Act or any amendment is deemed to be invalid or unenforceable in whole or in part.

 

*  *  *

 

(f) Mandatory Personal Injury Protection Endorsement- All-Terrain Vehicles (ATV)

 

MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT

ALL-TERRAIN VEHICLES (ATV)8

(New York)

8This endorsement shall be issued only for all-terrain vehicles.

 

The Company agrees with the named insured as follows: 

 

Section I

Mandatory Personal Injury Protection 

 

The company will pay first-party benefits to reimburse for basic economic loss sustained by an eligible injured person on account of personal injuries caused by an accident arising out of the use or operation of the insured ATV.  This coverage applies only to ATV accidents which occur during the policy period and on or after January 1, 1987 and within the State of New York.

 

Eligible Injured Person 

 

An eligible injured person is any person who sustains a personal injury arising out of the use or operation of the insured ATV while not occupying the insured ATV, any other ATV, any motorcycle or a motor vehicle. 

 

First-party Benefits 

 

First-party benefits, other than death benefits, are payments equal to basic economic loss, reduced by the following: 

 

(a) 20 percent of the eligible injured person's loss of earnings from work to the extent that an eligible injured person's basic economic loss consists of such loss of earnings; 

 

(b) amounts recovered or recoverable on account of personal injury to an eligible injured person under State or Federal laws providing social security disability or workers' compensation benefits, or disability benefits under article 9 of the New York Workers' Compensation Law.

 

Basic Economic Loss 

 

Basic economic loss shall consist of medical expense, work loss, other expense and, when death occurs, a death benefit as herein provided. Except for such death benefit, basic economic loss shall not include any loss sustained on account of death. Basic economic loss of each eligible injured person on account of any single accident shall not exceed $50,000 except that any death benefit hereunder shall be in addition thereto. 

 

Medical Expense 

 

Medical expense shall consist of necessary expenses for: 

 

(a) medical, hospital, surgical, nursing, dental, ambulance, X-ray, prescription drug and prosthetic services; 

 

(b) psychiatric, physical and occupational therapy and rehabilitation;

 

(c) any nonmedical remedial care and treatment rendered in accordance with a religious method of healing recognized by the laws of New York; and

 

(d) any other professional health services.

 

These medical expenses will not be subject to a time limitation, provided that within one year after the date of the accident it is ascertainable that further medical expenses may be sustained as a result of the injury.  Payments hereunder for necessary medical expenses shall be subject to the limitations and requirements of section 5108 of the New York Insurance Law.

 

Work Loss 

 

Work loss shall consist of the sum of the following losses and expenses, up to a maximum payment of $2,000 per month for a period of three years from the date of the accident: 

 

(a) loss of earnings from work which the eligible injured person would have performed had such person not been injured, except that an employee who is entitled to receive monetary payments, pursuant to statute or contract with the employer, or who receives voluntary monetary benefits paid for by the employer, by reason of such employee's inability to work because of personal injury arising out of the use or operation of an ATV shall not be entitled to receive first-party benefits for loss of earnings from work to the extent that such monetary payments or benefits from the employer do not result in the employee suffering a reduction in income or a reduction in such employee's level of future benefits arising from a subsequent illness or injury; and 

 

(b) reasonable and necessary expenses sustained by the eligible injured person in obtaining services in lieu of those which such person would have performed for income.

 

Other Expenses 

 

Other expenses shall consist of all reasonable and necessary expenses, other than medical expense and work loss, up to $25 per day for a period of one year from the date of the accident causing injury. 

 

Death Benefit 

 

Upon the death of any eligible injured person, caused by an accident to which this coverage applies, the Company will pay to the estate of such person a death benefit of $2,000. 

 

Exclusions9

9These exclusions may be deleted, in the event the Company wishes to provide coverage under the indicated circumstances.

 

This coverage does not apply: 

 

(a) to a personal injury sustained by any person who intentionally causes his own personal injury;

 

(b) to a personal injury sustained by any person while committing an act which would constitute a felony, or seeking to avoid lawful apprehension or arrest by a law enforcement officer; or

 

(c) to a personal injury sustained by a person while repairing, servicing, or otherwise maintaining a motor vehicle, motorcycle or ATV, if such conduct is within the course of a business of repairing, servicing, or otherwise maintaining a motor vehicle, motorcycle or ATV, and the injury occurs on the business premises.

 

Other Definitions 

 

When used in reference to this coverage: 

 

(a) the “insured ATV” means an ATV owned by the named insured and to which the bodily injury liability insurance of this policy applies and for which a specific premium is charged; 

 

(b) “motorcycle” means a vehicle as defined in section 123 of the New York Vehicle and Traffic Law, and which is required to carry financial security pursuant to article 6, 8 or 48-A of the Vehicle and Traffic Law;

 

(c) “all-terrain vehicle (ATV)” means a vehicle defined in section 2281 of the New York Vehicle and Traffic Law, which is required to carry financial security pursuant to articles 48-A and 48-C of the Vehicle and Traffic Law;

 

(d) “motor vehicle” means a motor vehicle, as defined in section 311 of the New York Vehicle and Traffic Law, and also includes fire and police vehicles, but shall not include any motor vehicle not required to carry financial security pursuant to article 6, 8 or 48-A of the Vehicle and Traffic Law, or a motorcycle or ATV, as defined above;

 

(e) “named insured” means the person or organization named [in the declaration];10

 

(f) “occupying” means in or upon or entering into or alighting from;

 

(g) “personal injury” means bodily injury, sickness or disease;

 

(h) “use or operation” of a motor vehicle, motorcycle or ATV includes the loading or unloading of such vehicle.

 

10Companies may substitute the appropriate term, reference or language for the matter set out in brackets.

 

Conditions 

 

Action Against Company.  No action shall lie against the Company, unless, as a condition precedent thereto, there shall have been full compliance with the terms of this coverage. 

 

Notice.  In the event of an accident, written notice setting forth details sufficient to identify the eligible injured person, along with reasonably obtainable information regarding the time, place and circumstances of the accident, shall be given by, or on behalf of, each eligible injured person, to the Company, or any of the Company's authorized agents, as soon as reasonably practicable, but in no event more than 30 days after the date of the accident, unless the eligible injured person submits written proof providing clear and reasonable justification for the failure to comply with such time limitation. If an eligible injured person or his legal representative institutes a proceeding to recover damages for personal injury under section 5104(b) of the New York Insurance Law, a copy of the summons and complaint or other process served in connection with such action shall be forwarded as soon as practicable to the Company or any of the Company's authorized agents by such eligible injured person or his legal representative. 

 

Proof of Claim;  Medical, Work Loss, and Other Necessary Expenses. In the case of a claim for health service expenses, the eligible injured person or that person’s assignee or representative shall submit written proof of claim to the Company, including full particulars of the nature and extent of the injuries and treatment received and contemplated, as soon as reasonably practicable but, in no event later than 45 days after the date services are rendered.  The eligible injured person or that person’s representative shall submit written proof of claim for work loss benefits and for other necessary expenses to the Company as soon as reasonably practicable but, in no event, later than 90 days after the work loss is incurred or the other necessary services are rendered. The foregoing time limitations for the submission of proof of claim shall apply unless the eligible injured person submits written proof providing clear and reasonable justification for the failure to comply with such time limitation. Upon request by the Company, the eligible injured person or that person’s assignee or representative shall:

 

(a) execute a written proof of claim under oath;

 

(b) as may reasonably be required submit to examinations under oath by any person named by the Company and subscribe the same;

 

(c) provide authorization that will enable the Company to obtain medical records; and

 

(d) provide any other pertinent information that may assist the Company in determining the amount due and payable.

 

The eligible injured person shall submit to medical examination by physicians selected by, or acceptable to, the Company, when, and as often as, the Company may reasonably require. 

 

Arbitration.  In the event any person making a claim for first-party benefits and the Company do not agree regarding any matter relating to the claim, such person shall have the option of submitting such disagreement to arbitration pursuant to procedures promulgated or approved by the Superintendent of Insurance. 

 

Reimbursement and Trust Agreement.  To the extent that the Company pays first-party benefits, the Company is entitled to the proceeds of any settlement or judgment resulting from the exercise of any right of recovery for damages for personal injury under section 5104(b) of the New York Insurance Law. The Company shall have a lien upon any such settlement or judgment to the extent that the Company has paid first-party benefits.  An eligible injured person shall: 

 

(a) hold in trust, for the benefit of the Company, all rights of recovery which he shall have for personal injury under section 5104(b) of the New York Insurance Law; 

 

(b) do whatever is proper to secure, and shall do nothing to prejudice, such rights; and

 

(c) execute, and deliver to the Company, instruments and papers as may be appropriate to secure the rights and obligations of such person and the Company established by this provision.

 

An eligible injured person shall not compromise an action to recover damages brought under section 5104(b) of the New York Insurance Law except: 

 

(a) with the written consent of the Company;

 

(b) with approval of the court; or

 

(c) where the amount of the settlement exceeds $50,000.

 

Other Coverage.  Where more than one source of first-party benefits required by article 51 of the New York Insurance Law and article 6 or 8 of the New York Vehicle and Traffic Law is available and applicable to an eligible injured person in any one accident, this Company is liable to an eligible injured person only for an amount equal to the maximum amount that the eligible injured person is entitled to recover under this coverage, divided by the number of available and applicable sources of required first-party benefits. An eligible injured person shall not recover duplicate benefits for the same elements of loss under this coverage or any other mandatory first-party automobile or no-fault automobile insurance coverage issued in compliance with the laws of another state.

 

If the eligible injured person is entitled to benefits under any such mandatory first-party automobile or no-fault automobile insurance for the same elements of loss under this coverage, this Company shall be liable only for an amount equal to the proportion that the total amount available under this coverage bears to the sum of the amount available under this coverage and the amount available under such other mandatory insurance of the common elements of loss. However, where another state's mandatory first-party or no-fault automobile insurance law provides unlimited coverage available to an eligible injured person for an element of loss under this coverage, the obligation of this Company is to share equally for that element of loss with such other mandatory insurance until the $50,000 limit of this coverage is exhausted by the payment of that element of loss and any other elements of loss.

 

Section II

Excess Coverage 

 

If medical payments coverage or any disability coverages or uninsured motorists coverage are afforded under this policy, such coverages shall be excess insurance over any mandatory or additional personal injury protection benefits paid or payable, or which would be paid or payable but for the application of a deductible under this or any other automobile no-fault insurance policy. 

 

Section III

Constitutionality 

 

If it is conclusively determined by a court of competent jurisdiction that the New York Comprehensive Motor Vehicle Insurance Reparations Act, or any amendment thereto, is invalid or unenforceable in whole or in part, then, subject to the approval of the Superintendent of Insurance, the Company may amend this policy and may also recompute the premium for the existing or amended policy. 

 

These amendments and recomputations will be effective retroactively to the date that such Act or any amendment is deemed to be invalid or unenforceable in whole or in part. 

 

*    *    *

 

(g) Notwithstanding any of the provisions of these endorsements, the Company shall provide at least for the payment of first-party benefits pursuant to section 5103 of the Insurance Law, and these endorsements shall be construed as if such coverage were embodied therein. 

 

65-1.2  Requirements for Optional Basic Economic Loss Coverage.

 

(a) The Optional Basic Economic Loss Coverage Endorsement (New York), set out below is approved and promulgated for use by an insurer and, except as provided in section 65-1.7 of this Subpart, must be furnished to all insureds who purchase Optional Basic Economic Loss (OBEL) coverage. 

 

 

OPTIONAL BASIC ECONOMIC LOSS COVERAGE ENDORSEMENT

(New York)

 

The Company agrees with the named insured, subject to all of the provisions, exclusions and conditions of the MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT (New York) not expressly modified in this Endorsement, as follows: 

 

The definition of Basic Economic Loss contained in the MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT (New York) or the MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT-MOTORCYCLES (New York) is replaced by the following: 

 

Basic Economic Loss: 

 

Basic economic loss shall consist of medical expense, work loss, other expense and, when death occurs, a death benefit as herein provided. Except for such death benefit, basic economic loss shall not include any loss sustained on account of death. Basic economic loss of each eligible injured person on account of any single accident shall not exceed $75,000, the last $25,000 of which represents optional basic economic loss coverage, payable after the first $50,000 of basic economic loss has been exhausted, that the eligible injured person or that person’s legal representative may specify will be applied to one of the following four options: 

 

(a) basic economic loss;

 

(b) loss of earnings from work;

 

(c) psychiatric, physical or occupational therapy and rehabilitation; or

 

(d) a combination of options (b) and (c).

 

Any death benefit hereunder shall be in addition thereto. 

 

Exclusion (c) set forth in the MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT (New York) is replaced by the following:

 

(c) the named insured or relative while occupying, or while a pedestrian through being struck by, a motor vehicle in New York State, other than the insured motor vehicle, with respect to which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is in effect; however, this exclusion does not apply to:

 

(1) the Optional Basic Economic Loss coverage provided under this endorsement, unless OBEL coverage is provided by the policy covering the other motor vehicle; or

 

(2) to personal injury sustained in New York State by the named insured or relative while occupying a bus or school bus, as defined in sections 104 and 142 of the  New York Vehicle and Traffic Law, unless that person is the operator, an owner, or an employee of the owner or operator, of such bus or school bus.

 

Election

 

Election of the OBEL option shall be made by the eligible injured person or that person’s legal representative after such person has incurred expense aggregating $30,000 in basic economic loss and after receiving the required notices from the Company that an OBEL election may be made. Failure of the eligible injured person or that person’s legal representative to respond to the second notice within 15 calendar days after its mailing shall be considered an election by the eligible injured person to apply OBEL coverage to all elements of basic economic loss. Once made by the eligible injured person or that person’s legal representative, an OBEL election cannot be changed. However, if claims payable under OBEL coverage have not yet been received by the Company, an eligible injured person who has failed to respond to the second notice in a timely manner may make an election.

 

Notice

 

If OBEL coverage is payable under this policy, but Mandatory PIP is being paid under a policy covering another motor vehicle, then the named insured or relative shall notify the Company no later than 90 days after Mandatory PIP benefits under that other policy have been exhausted. The Company shall then send its OBEL election notice.

 

(b) The insurer shall in connection with new policy applications offer applicants OBEL coverage by sending the applicant the following letter: 

 

Dear Applicant: 

 

Optional Basic Economic Loss (OBEL) coverage is being offered to you as an enhancement of the Basic No-Fault coverage you are presently required to purchase. But before we describe this coverage, we would like to advise you what benefits Basic No-Fault coverage does and does not provide. 

 

No-Fault coverage, otherwise known as Personal Injury Protection or "PIP" coverage, pays for expenses incurred by persons injured in a motor vehicle accident. This coverage does not pay to repair damage to your automobile. 

 

Basic No-Fault, which you are required by law to purchase, provides coverage of up to $50,000 per person in benefits for: 

 

1. all necessary doctor and hospital bills and other health service expenses, payable in accordance with fee schedules established or adopted by the New York State Insurance Department; and 

 

2. 80% of lost earnings up to a maximum monthly payment of $2,000 for up to three years following the date of accident; and 

 

3. up to $25 per day for a period of one year from the date of the accident for other reasonable and necessary expenses the injured person may have incurred because of an injury resulting from the accident, such as the cost of hiring a housekeeper or necessary transportation expenses to and from a health service provider; and 

 

4. a $2,000 death benefit, payable to the estate of a covered person, in addition to the $50,000 coverage for economic loss described above. 

 

No-Fault benefits will be reduced by other benefits that are payable under Workers' Compensation, Social Security Disability, New York State Disability, and certain employer "wage continuation" plans where an employee does not lose any future sick leave benefits. 

[In addition to the basic No-Fault coverage described, higher limits of up to ________________, including payments of up to ____________ for loss of earnings and up to_____________ for other reasonable and necessary expenses, are available for purchase upon request.]11

 

OPTIONAL COVERAGE AVAILABLE

 

In addition to Basic No-Fault Coverage, you may also purchase OBEL coverage that will pay certain expenses, up to $25,000, above the Basic No-Fault limit of $50,000. OBEL coverage is different from other coverages in that a claimant can select the kinds of benefits to be paid under OBEL. 

 

If you purchase OBEL coverage and if it appears likely that a claimant will use up the Basic No-Fault coverage, your insurer will send the claimant a form for the claimant to choose what expenses the $25,000 in OBEL coverage will be used to pay. Under No-Fault, a claimant could include you, family members, passengers in your car, or pedestrians, if injured in an auto accident. 

The claimant will be able to choose one of the following four OBEL options and thereby direct the insurer to pay expenses for: 

 

1. basic economic loss, whether health care expenses, loss of earnings from work, or other reasonable and necessary expenses; 

 

2.  loss of earnings from work;

 

3. psychiatric, physical or occupational therapy and rehabilitation; or

 

4. a combination of options 2 and 3. 

 

The additional $25,000 of OBEL coverage will be used only for costs incurred under the chosen option, which, once selected, the claimant cannot change. 

 

If you have any questions, please contact your company or agent. 

 

 

65-1.3  Requirements for Additional Personal Injury Protection Coverage.

 

(a) The Additional Personal Injury Protection Endorsement (New York), set out in this section, is approved and promulgated and all of the provisions thereof shall, in accordance with section 2307(b) of the Insurance Law, be deemed to be included in all additional personal injury protection endorsements in force.  This endorsement contains non-substantive changes from the previously prescribed Additional Personal Injury Protection Endorsement (New York) and may be substituted for that endorsement when supplies of that endorsement are exhausted.  This endorsement may be combined with the Mandatory Personal Injury Protection Endorsement (New York) and other coverages, with appropriate language.

 

11 This Additional PIP language may be deleted at the insurer’s option.

 

(b) The endorsement set forth in this section may include the following provision, together with appropriate schedule(s) of named individuals: “It is agreed that the individual(s) named in this endorsement shall be deemed to be a named insured under the Mandatory Personal Injury Protection Endorsement (New York) and, to the extent applicable, this endorsement.”

 

(c) Additional Personal Injury Protection Endorsement

 

ADDITIONAL PERSONAL INJURY PROTECTION ENDORSEMENT

 (New York)

 

The Company agrees with the named insured subject to all of the provisions, exclusions and conditions of the Mandatory Personal Injury Protection (Endorsement)12 (New York), not expressly modified in this (Endorsement)12 as follows: 

 

Additional Personal Injury Protection 

 

The Company will pay additional first-party benefits to reimburse for extended economic loss on account of personal injuries sustained by an eligible injured person and caused by an accident arising out of the use or operation of a motor vehicle or motorcycle during the policy period.  This coverage only applies to motor vehicle accidents within the United States of America, its territories or possessions, or Canada.

 

Eligible Injured Person 

 

Subject to the exclusions and conditions set forth below, an eligible injured person is: 

 

(a) the named insured and any relative who sustains personal injury arising out of the use or operation of any motor vehicle;

 

(b) the named insured and any relative who sustains personal injury arising out of the use or operation of any motorcycle while not occupying a motorcycle;

 

(c) any other person who sustains personal injury arising out of the use or operation of the insured motor vehicle while occupying the insured motor vehicle; or

 

(d) any other person who sustains personal injury arising out of the use or operation of any other motor vehicle (other than a public or livery conveyance) while occupying such other motor vehicle, if such other motor vehicle is being operated by the named insured or any relative.

 

12Companies may substitute the appropriate term, reference or language for the matter set out in parenthesis.

 

Exclusions 

 

This coverage does not apply to personal injury sustained by: 

 

(a) any person while occupying a motor vehicle owned by such person with respect to which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is not in effect;

 

(b) any person while occupying, or while a pedestrian through being struck by, a motor vehicle owned by the named insured with respect to which additional personal injury protection coverage is not provided under this policy;

 

(c) any relative while occupying, or while a pedestrian through being struck by, a motor vehicle owned by such relative with respect to which additional personal injury protection coverage is not provided under this policy;

 

(d) any New York State resident other than the named insured or relative injured through the use or operation of a motor vehicle outside of New York State if such resident is the owner of a motor vehicle for which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is not in effect;

 

(e) any person while occupying a motorcycle;

 

(f) any person who intentionally causes his own personal injury;13

 

(g) any person as a result of operating a motor vehicle while in an intoxicated condition or while his ability to operate such vehicle is impaired by the use of a drug (within the meaning of section 1192 of the New York Vehicle and Traffic Law)13; or

 

(h) any person while:

 

(i) committing an act which would constitute a felony, or seeking to avoid lawful apprehension or arrest by a law enforcement officer;13

 

(ii) operating a motor vehicle in a race or speed test;13

 

(iii) operating or occupying a motor vehicle known to him to be stolen; or13

 

13These exclusions may be deleted, in the event the Company wishes to provide coverage under the indicated circumstances.

 

(iv) repairing, servicing, or otherwise maintaining a motor vehicle if such conduct is within the course of a business of repairing, servicing or otherwise maintaining a motor vehicle and the injury occurs on the business premises.13

 

Additional First-party Benefits 

 

Additional first-party benefits are payments equal to extended economic loss reduced by: 

 

(a) 20 percent of the eligible injured person’s loss of earnings from work, to the extent that the extended economic loss covered by this [Endorsement]14 includes such loss of earnings;

 

(b) amounts recovered or recoverable on account of personal injury to an eligible injured person under State or Federal laws providing social security disability or workers’ compensation benefits or disability benefits under article 9 of the New York Workers’ Compensation law, which amounts have not been applied to reduce first-party benefits recovered or recoverable under basic economic loss;

 

(c) amounts recovered or recoverable by the eligible injured person for any element of extended economic loss covered by this [Endorsement]14 under any mandatory source of first-party automobile no-fault benefits required by the laws of any state (other than the State of New York) of the United States of America, its possessions or territories, or by the laws of any province of Canada.

 

Extended Economic Loss 

 

Extended economic loss shall consist of the following:

 

(a) basic economic loss sustained on account of an accident occurring within the United States of America, its possessions or territories, or Canada, which is not recovered or recoverable under a policy issued in satisfaction of the requirements of article 6 or 8 of the New York Vehicle and Traffic law and article 51 of the New York Insurance Law;

(b) the difference between

 

(i) basic economic loss; and

 

(ii) basic economic loss recomputed in accordance with the time and dollar limits [set out in the declarations]; 14 and

 

[(c) an additional death benefit in the amount set out in the declarations]15

 

14 Companies may substitute the appropriate term, reference or language for the matter set out in brackets.

15Language in brackets may be deleted if additional death benefits are not offered.

 

Two or More Motor Vehicles Insured Under This Policy

 

The limit of liability under this [Endorsement] 14 applicable to injuries sustained by an eligible injured person while occupying, or while a pedestrian through being struck by, the insured motor vehicle shall be as stated [in the declarations]14 for that insured motor vehicle. The limit of liability for injuries covered by this [Endorsement] 16 and sustained by an eligible injured person while occupying, or while a pedestrian through being struck by, a motor vehicle, other than the insured motor vehicle, shall be the highest limit stated for this coverage in the declarations for any insured motor vehicle under this policy.

 

 

Arbitration

 

In the event any person making a claim for additional first-party benefits and the Company do not agree regarding any matter relating to the claim, such person shall have the option of submitting such disagreement to arbitration pursuant to procedures promulgated or approved by the Superintendent of Insurance.

 

Subrogation 

 

In the event of any payment for extended economic loss, the Company is subrogated to the extent of such payments to the rights of the person to whom, or for whose benefit, such payments were made. Such person must execute and deliver instruments and papers and do whatever else is necessary to secure such rights. Such person shall do nothing to prejudice such rights.

 

Other Coverage; Nonduplication

 

The eligible injured person shall not recover duplicate benefits for the same elements of loss covered by this [Endorsement]17 or any other optional first-party automobile or no-fault automobile insurance coverage.

 

If an eligible injured person is entitled to New York mandatory and additional personal injury protection benefits under any other policy, and if such eligible injured person is not entitled to New York mandatory personal injury protection benefits under this policy, then the coverage provided under this Additional Personal Injury Protection Endorsement (New York) shall be excess over such other New York mandatory and additional personal injury protection benefits.

 

When coverage provided under this [Endorsement]17 applies on an excess basis, it shall apply only in the amount by which the total limit of liability of New York mandatory and additional personal injury protection coverage available under this policy exceeds the total limit of liability for any other applicable New York mandatory and additional personal injury protection coverage.

 

16 Companies may substitute the appropriate term, reference or language for the matter set out in brackets.

17 Companies may substitute the appropriate term, reference or language for the matter set out in brackets.

 

Subject to the provisions of the preceding three paragraphs, if the eligible injured person is entitled to benefits under any other optional first-party automobile or no-fault automobile insurance for the same elements of loss covered by this [Endorsement]17 this Company shall be liable only for an amount equal to the proportion that the total amount available under this [Endorsement]17 bears to the sum of the amounts available under this [Endorsement] 18 and such other optional insurance, for the same element of loss.

 

65-1.4  Medical Expense Exclusion.

 

The Exclusion of Medical Expense from Mandatory Personal Injury Protection Endorsement (New York), set out below is approved and promulgated for use in accordance with the provisions of section 5103(g) of the Insurance Law. This endorsement may be used as a separate endorsement or appropriately added to the mandatory endorsement.

 

EXCLUSION OF MEDICAL EXPENSE FROM MANDATORY

PERSONAL INJURY PROTECTION ENDORSEMENT

(New York)

 

In consideration of a reduction in premium, it is agreed that: 

 

If the Medical Expense element of Basic Economic Loss is identified as not applicable [in the declarations]18 the Company shall not be liable for any items of such loss which would otherwise be covered under the Mandatory Personal Injury Protection Endorsement (New York) with respect to the named insured or named insured and any relative as specified [in the declarations]18 Coverage for any such medical expense element of basic economic loss provided to such named insured, or such relative, by a company or corporation in accordance with the provisions of section 5103(g) of the New York Insurance Law shall reduce the $50,000 aggregate limit of liability for basic economic loss to such person under this policy. This endorsement shall be effective during the term of this policy so long as the medical expense coverage provided by such company or corporation remains in effect, notwithstanding any provisions [in the declarations] 18 of this policy to the contrary, and in the event this endorsement shall no longer be in effect the premium may be adjusted accordingly. 

 

65-1.5  Declarations Page Requirements for policies insuring a motor vehicle.

 

(a) The declarations page of each policy must specify the dollar amount of basic economic loss coverage under the policy and, if the insured has purchased OBEL coverage, OBEL coverage shall be separately identified on the declarations page of the policy. 

 

(b) If Additional PIP coverage is purchased by the policyholder, the declarations page shall state:

 

                     (i) the basic economic loss limits (Mandatory PIP coverage and, if purchased, OBEL coverage);

 

18 Companies may substitute the appropriate term, reference or language for the matter set out in brackets.

(ii) the maximum amount payable under Additional PIP coverage; and 

 

(iii) the aggregate amount payable as PIP benefits, including the maximum amounts payable as work loss benefits, other expenses and the death benefit.

 

65-1.6  Deductibles.

 

Each insurance company which offers insurance policies to satisfy the minimum requirements of article 51 shall offer the policy prescribed in this Subpart with a family deductible of $200 and without any deductible. Each insurance company may also offer the above policy with a family deductible of $100. Any family deductible shall apply to the "named insured" and any "relative," as these terms are defined in the Mandatory Personal Injury Protection Endorsement set forth in this Subpart. 

 

65-1.7  Deviations.

 

Deviations from these endorsements prescribed by this Subpart may be submitted for prior approval, but approval will not be granted for any reduction in first-party benefits payable to eligible injured persons, or any changes in form alone, or nonsubstantive or editorial deviations or minor deviations in first-party benefits or other provisions. 

 

65-1.8  Coverage for nonresident motorists driving in this State.

 

(a)  The automobile liability insurance policies of every authorized insurer which are sold in any other state or Canadian province shall be deemed to satisfy the financial security requirements of article 6 or 8 of the New York Vehicle and Traffic Law, and shall be deemed to provide for the payment of first-party benefits pursuant to section 5103 of the New York Insurance Law when the insured motor vehicle is used or operated in this State. 

 

(b) The automobile liability insurance policies which are sold in any other state or Canadian province by an unauthorized insurer which is controlled by, or controlling, or under common control of, an authorized insurer shall be deemed to satisfy the financial security requirements of article 6 or 8 of the New York Vehicle and Traffic Law, and shall be deemed to provide for the payment of first-party benefits pursuant to section 5103 of the New York Insurance Law when the insured motor vehicle is used or operated in this State. 

 

(c) Any other unauthorized insurer may file with the Superintendent of Insurance a statement that its automobile insurance policies sold in any other state or Canadian province will be deemed to satisfy the financial security requirements of article 6 or 8 of the New York Vehicle and Traffic Law, and will be deemed to provide for the payment of first-party benefits pursuant to section 5103 of the New York Insurance Law when the insured motor vehicle is used or operated in this State

 

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