2013 New York Consolidated Laws
ISC - Insurance
Article 51 - (5101 - 5109) COMPREHENSIVE MOTOR VEHICLE INSURANCE REPARATIONS
5103 - Entitlement to first party benefits; additional financial security required.


NY Ins L § 5103 (2012) What's This?
 
    §  5103.  Entitlement  to  first  party benefits; additional financial
  security required. (a)  Every  owner's  policy  of  liability  insurance
  issued on a motor vehicle in satisfaction of the requirements of article
  six  or  eight  of  the  vehicle and traffic law shall also provide for;
  every owner who maintains another form of financial security on a  motor
  vehicle  in  satisfaction  of the requirements of such articles shall be
  liable for; and every owner of a motor vehicle required to be subject to
  the provisions of this article  by  subdivision  two  of  section  three
  hundred  twenty-one  of the vehicle and traffic law shall be liable for;
  the payment of first party benefits to:
    (1) Persons, other than  occupants  of  another  motor  vehicle  or  a
  motorcycle,  for  loss arising out of the use or operation in this state
  of such motor vehicle. In the case of occupants  of  a  bus  other  than
  operators,  owners,  and  employees of the owner or operator of the bus,
  the coverage for first party benefits shall be afforded under the policy
  or policies, if any, providing  first  party  benefits  to  the  injured
  person  and  members of his household for loss arising out of the use or
  operation of any motor vehicle of such household. In the event there  is
  no such policy, first party benefits shall be provided by the insurer of
  such bus.
    (2)  The  named  insured  and  members  of  his  household, other than
  occupants of a motorcycle, for loss arising out of the use or  operation
  of  (i)  an  uninsured  motor  vehicle  or motorcycle, within the United
  States, its territories or possessions, or Canada; and (ii)  an  insured
  motor  vehicle or motorcycle outside of this state and within the United
  States, its territories or possessions, or Canada.
    (3) Any New York resident who is neither the owner of a motor  vehicle
  with  respect  to which coverage for first party benefits is required by
  this article nor, as a member of a household, is entitled to first party
  benefits under paragraph two of this subsection, for loss arising out of
  the use or operation  of  the  insured  or  self-insured  motor  vehicle
  outside  of  this state and within the United States, its territories or
  possessions, or Canada.
    (4) The estate of any  covered  person,  other  than  an  occupant  of
  another  motor vehicle or a motorcycle, a death benefit in the amount of
  two thousand dollars for the death of such person arising out of the use
  or operation of such motor vehicle which is in  addition  to  any  first
  party benefits for basic economic loss.
    (b)  An  insurer  may exclude from coverage required by subsection (a)
  hereof a person who:
    (1) Intentionally causes his own injury.
    (2) Is injured 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  eleven
  hundred  ninety-two  of  the vehicle and traffic law; provided, however,
  that an insurer shall not exclude such person from coverage with respect
  to necessary emergency health services rendered in a  general  hospital,
  as  defined in subdivision ten of section two thousand eight hundred one
  of the public health law, including ambulance services attendant thereto
  and related medical screening. Notwithstanding any other law, where  the
  covered  person  is  found  to  have  violated  section  eleven  hundred
  ninety-two of the vehicle and traffic law, the insurer has  a  cause  of
  action  for the amount of first party benefits paid or payable on behalf
  of such covered person against such covered person.
    (3) Is injured  while  he  is:  (i)  committing  an  act  which  would
  constitute  a  felony, or seeking to avoid lawful apprehension or arrest
  by a law enforcement officer, or (ii) operating a  motor  vehicle  in  a
  race  or  speed  test,  or  (iii) operating or occupying a motor vehicle

  known to him to be stolen, or (iv)  operating  or  occupying  any  motor
  vehicle  owned by such injured person with respect to which the coverage
  required by subsection (a) hereof is not in effect, or (v) a pedestrian,
  through  being  struck  by  any  motor  vehicle  owned  by  such injured
  pedestrian with respect to which the coverage required by subsection (a)
  hereof is not in effect,  or  (vi)  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.
    (c)  Insurance  offered  by any company to satisfy the requirements of
  subsection (a) hereof shall be offered (i) without a deductible and (ii)
  with a family deductible of up to two hundred dollars (which  deductible
  shall  apply  only  to  the loss of the named insured and members of his
  household). The superintendent may approve a higher  deductible  in  the
  case  of insurance policies providing additional benefits or pursuant to
  a plan designed and implemented to coordinate first party benefits  with
  other benefits.
    (d)  Insurance  policy forms for insurance to satisfy the requirements
  of subsection (a) hereof  shall  be  subject  to  approval  pursuant  to
  article twenty-three of this chapter. Minimum benefit standards for such
  policies  and  for self-insurers, and rights of subrogation, examination
  and other such matters, shall be established by regulation  pursuant  to
  section three hundred one of this chapter.
    (e) Every owner's policy of liability insurance issued in satisfaction
  of  article  six  or  eight  of  the  vehicle and traffic law shall also
  provide, when a motor vehicle covered by such policy is used or operated
  in any other state or in any Canadian province, insurance  coverage  for
  such  motor  vehicle at least in the minimum amount required by the laws
  of that state or province.
    (f) Every owner's policy of liability insurance issued on a motorcycle
  or an all terrain vehicle in satisfaction of the requirements of article
  six or eight of the vehicle  and  traffic  law  or  section  twenty-four
  hundred  seven  of  such  law  shall  also  provide for; every owner who
  maintains another form of financial security on a motorcycle or  an  all
  terrain  vehicle in satisfaction of the requirements of such articles or
  section shall be liable for; and every owner of a motorcycle or  an  all
  terrain vehicle required to be subject to the provisions of this article
  by subdivision two of section three hundred twenty-one of such law shall
  be  liable  for;  the  payment of first party benefits to persons, other
  than the occupants of such motorcycle or all  terrain  vehicle,  another
  motorcycle  or  all  terrain  vehicle,  or  any  motor vehicle, for loss
  arising out of the use or operation of the  motorcycle  or  all  terrain
  vehicle  within  this  state. Every insurer and self-insurer may exclude
  from the coverage required by this subsection a person who intentionally
  causes his own injury or is injured while committing an act which  would
  constitute  a  felony  or  while seeking to avoid lawful apprehension or
  arrest by a law enforcement officer.
    (g) A  company  authorized  to  provide  the  insurance  specified  in
  paragraph  three  of  subsection (a) of section one thousand one hundred
  thirteen of this chapter or a corporation organized pursuant to  article
  forty-three  of  this  chapter  may,  individually  or jointly, with the
  approval of the superintendent  upon  a  showing  that  the  company  or
  corporation  is  qualified  to  provide  for  all  of the items of basic
  economic loss specified in paragraph one of subsection  (a)  of  section
  five thousand one hundred two of this article, provide coverage for such
  items  of  basic  economic  loss  to the extent that an insurer would be
  required to provide under this article. Where a policyholder  elects  to
  be  covered under such an arrangement the insurer providing coverage for

  the automobile shall be furnished with the names of all persons  covered
  by  the  company  or  corporation under the arrangement and such persons
  shall not be entitled to benefits for any of the items of basic economic
  loss  specified  in  such  paragraph.  The  premium  for  the automobile
  insurance  policy  shall  be  appropriately  reduced  to   reflect   the
  elimination  of coverage for such items of basic economic loss. Coverage
  by the automobile insurer of such eliminated items shall be effected  or
  restored upon request by the insured and payment of the premium for such
  coverage. All companies and corporations providing coverage for items of
  basic  economic  loss  pursuant  to the authorization of this subsection
  shall have only those rights and obligations which are applicable to  an
  insurer subject to this article.
    (h) Any policy of insurance obtained to satisfy the financial security
  requirements  of  article  six  or  eight of the vehicle and traffic law
  which does not contain provisions complying  with  the  requirements  of
  this  article,  shall  be  construed as if such provisions were embodied
  therein.

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