N.Y. Insurance Law § 5102: Definitions

§ 5102. Definitions. In this chapter:

(a) "Basic economic loss" means, up to fifty thousand dollars per

person of the following combined items, subject to the limitations of

section five thousand one hundred eight of this article:

(1) All necessary expenses incurred for: (i) medical, hospital

(including services rendered in compliance with article forty-one 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; (ii) psychiatric, physical therapy

(provided that treatment is rendered pursuant to a referral) and

occupational therapy and rehabilitation (provided that treatment is

rendered pursuant to a referral); (iii) any non-medical remedial care

and treatment rendered in accordance with a religious method of healing

recognized by the laws of this state; and (iv) any other professional

health services; all without limitation as to time, provided that within

one year after the date of the accident causing the injury it is

ascertainable that further expenses may be incurred as a result of the

injury. For the purpose of determining basic economic loss, the expenses

incurred under this paragraph shall be in accordance with the

limitations of section five thousand one hundred eight of this article.

(2) Loss of earnings from work which the person would have performed

had he not been injured, and reasonable and necessary expenses incurred

by such person in obtaining services in lieu of those that he would have

performed for income, up to two thousand dollars per month for not more

than three years from the date of the accident causing the injury. 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 the employee's

inability to work because of personal injury arising out of the use or

operation of a motor vehicle, is not 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 the

employee's level of future benefits arising from a subsequent illness or

injury.

(3) All other reasonable and necessary expenses incurred, up to

twenty-five dollars per day for not more than one year from the date of

the accident causing the injury.

(4) "Basic economic loss" shall not include any loss incurred on

account of death; subject, however, to the provisions of paragraph four

of subsection (a) of section five thousand one hundred three of this

article.

(5) "Basic economic loss" shall also include an additional option to

purchase, for an additional premium, an additional twenty-five thousand

dollars of coverage which the insured or his legal representative may

specify will be applied to loss of earnings from work and/or

psychiatric, physical or occupational therapy and rehabilitation after

the initial fifty thousand dollars of basic economic loss has been

exhausted. This optional additional coverage shall be made available and

notice with explanation of such coverage shall be provided by an insurer

at the first policy renewal after the effective date of this paragraph,

or at the time of application.

(b) "First party benefits" means payments to reimburse a person for

basic economic loss on account of personal injury arising out of the use

or operation of a motor vehicle, less:

(1) Twenty percent of lost earnings computed pursuant to paragraph two

of subsection (a) of this section.

(2) Amounts recovered or recoverable on account of such injury under

state or federal laws providing social security disability benefits, or

workers' compensation benefits, or disability benefits under article

nine of the workers' compensation law, or medicare benefits, other than

lifetime reserve days and provided further that the medicare benefits

utilized herein do not result in a reduction of such person's medicare

benefits for a subsequent illness or injury.

(3) Amounts deductible under the applicable insurance policy.

(c) "Non-economic loss" means pain and suffering and similar

non-monetary detriment.

(d) "Serious injury" means a personal injury which results in death;

dismemberment; significant disfigurement; a fracture; loss of a fetus;

permanent loss of use of a body organ, member, function or system;

permanent consequential limitation of use of a body organ or member; or

significant limitation of use of a body function or system.

(e) "Owner" means an owner as defined in section one hundred

twenty-eight of the vehicle and traffic law.

(f) "Motor vehicle" means a motor vehicle as defined in section three

hundred eleven of the vehicle and traffic law and also includes fire and

police vehicles. It shall not include any motor vehicle not required to

carry financial security pursuant to article six, eight or forty-eight-A

of the vehicle and traffic law or a motorcycle, as defined in subsection

(m) hereof.

(g) "Insurer" means the insurance company or self-insurer, as the case

may be, which provides the financial security required by article six,

eight, or forty-four-B of the vehicle and traffic law.

(h) "Member of his household" means a spouse, child or relative of the

named insured who regularly resides in his household.

(i) "Uninsured motor vehicle" means a motor vehicle, the owner of

which is (i) a financially irresponsible motorist as defined in

subsection (j) of section five thousand two hundred two of this chapter

or (ii) unknown and whose identity is unascertainable.

(j) "Covered person" means any pedestrian injured through the use or

operation of, or any owner, operator or occupant of, a motor vehicle

which has in effect the financial security required by article six or

eight of the vehicle and traffic law or which is referred to in

subdivision two of section three hundred twenty-one of such law; or any

other person entitled to first party benefits.

(k) "Bus" means both a bus and a school bus as defined in sections one

hundred four and one hundred forty-two of the vehicle and traffic law.

(l) "Compensation provider" means the state insurance fund, or the

person, association, corporation or insurance carrier or statutory fund

liable under state or federal laws for the payment of workers'

compensation benefits or disability benefits under article nine of the

workers' compensation law.

(m) "Motorcycle" means any motorcycle, as defined in section one

hundred twenty-three of the vehicle and traffic law, and which is

required to carry financial security pursuant to article six, eight or

forty-eight-A of the vehicle and traffic law.