N.Y. Insurance Law § 5103: Entitlement to first party benefits; additional financial security required

§ 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.

(4) Is injured while a motor vehicle is being used or operated by a

TNC driver pursuant to article forty-four-B of the vehicle and traffic

law, provided, however, that only the insurer issuing the owner's policy

of liability insurance providing coverage for the motor vehicle being

operated by a TNC driver may exclude such coverage and an insurer may

not include this exclusion in a policy used to satisfy the requirements

under article forty-four-B of the vehicle and traffic law.

5. Is injured while a motor vehicle is being used or operated by a

shared vehicle driver pursuant to article forty of the general business

law, provided, however, that only the insurer issuing the owner's policy

of liability insurance providing coverage for the motor vehicle being

used or operated by a shared vehicle driver may exclude such coverage

and an insurer may not include this exclusion in a policy used to

satisfy the requirements of article forty of the general business law.

(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.