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