S T A T E O F N E W Y O R K
________________________________________________________________________
4288
2011-2012 Regular Sessions
I N A S S E M B L Y
February 2, 2011
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Introduced by M. of A. P. RIVERA -- read once and referred to the
Committee on Insurance
AN ACT to amend the insurance law, in relation to the terms of motor
vehicle liability insurance policies
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Section 5103 of the insurance law is amended by adding a
new subsection (i) to read as follows:
(I) EVERY OWNER'S POLICY OF LIABILITY INSURANCE ISSUED ON A MOTOR
VEHICLE OR A MOTORCYCLE IN SATISFACTION OF THE REQUIREMENTS OF ARTICLE
SIX OR EIGHT OF THE VEHICLE AND TRAFFIC LAW SHALL CONTAIN THE PROVISIONS
SPECIFIED IN THIS SUBSECTION IN THE WORDS IN WHICH SUCH PROVISIONS
APPEAR, EXCEPT THAT AN INSURER MAY, AT ITS OPTION, SUBSTITUTE FOR ONE OR
MORE OF SUCH PROVISIONS CORRESPONDING PROVISIONS OF DIFFERENT WORDING
APPROVED BY THE SUPERINTENDENT WHICH ARE NOT LESS FAVORABLE IN ANY
RESPECT TO THE INSURED OR ANY COVERED PERSON. EACH PROVISION CONTAINED
IN THE POLICY SHALL BE PRECEDED BY THE APPLICABLE CAPTION OR, AT THE
INSURER'S OPTION, BY SUCH APPROPRIATE CAPTIONS OR SUBCAPTIONS AS THE
SUPERINTENDENT MAY APPROVE.
(1) EACH POLICY SHALL, EXCEPT WITH RESPECT TO DESIGNATION BY NUMBERS
OR LETTERS, CONTAIN THE FOLLOWING PROVISIONS:
(A) ACTION AGAINST INSURER. NO ACTION SHALL LIE AGAINST THE INSURER
UNLESS, AS A CONDITION PRECEDENT THERETO, THERE SHALL HAVE BEEN FULL
COMPLIANCE WITH THE TERMS OF THIS COVERAGE.
(B) 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 CIRCUM-
STANCES OF THE ACCIDENT, SHALL BE GIVEN BY, OR ON BEHALF OF, EACH ELIGI-
BLE INJURED PERSON, TO THE INSURER, OR ANY OF THE INSURER'S AUTHORIZED
AGENTS, AS SOON AS REASONABLY PRACTICABLE, BUT IN NO EVENT MORE THAN SIX
MONTHS AFTER THE DATE OF THE ACCIDENT, UNLESS THE ELIGIBLE INJURED
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00410-01-1
A. 4288 2
PERSON SUBMITS WRITTEN PROOF PROVIDING A JUSTIFICATION FOR THE FAILURE
TO COMPLY WITH SUCH TIME LIMITATION WHICH IS REASONABLE BY A PREPONDER-
ANCE OF EVIDENCE. IF AN ELIGIBLE INJURED PERSON OR THAT PERSON'S LEGAL
REPRESENTATIVE INSTITUTES A PROCEEDING TO RECOVER DAMAGES FOR PERSONAL
INJURY UNDER SUBSECTION (B) OF SECTION FIVE THOUSAND ONE HUNDRED FOUR OF
THIS ARTICLE, A COPY OF THE SUMMONS AND COMPLAINT OR OTHER PROCESS
SERVED IN CONNECTION WITH SUCH ACTION SHALL BE FORWARDED WITHIN SIX
MONTHS AFTER THE DATE OF THE ACCIDENT TO THE INSURER OR ANY OF THE
INSURER'S AUTHORIZED AGENTS BY SUCH ELIGIBLE INJURED PERSON OR THAT
PERSON'S LEGAL REPRESENTATIVE. IN ANY INSTANCE IN WHICH AN ELIGIBLE
INJURED PERSON IS UNABLE AFTER MAKING A REASONABLE EFFORT TO ASCERTAIN
WHETHER THE INSURER IS LIABLE FOR SUCH PERSON'S CLAIM, NOTICE SHALL BE
DEEMED TO HAVE BEEN MADE UPON THE APPROPRIATE INSURER, IF SUCH NOTICE
SHALL HAVE BEEN SERVED UPON THE STATE INSURANCE FUND. THE ELIGIBLE
INJURED PERSON SHALL BE DEEMED TO HAVE MADE A REASONABLE EFFORT TO
ASCERTAIN THE APPROPRIATE INSURER, IF HE OR SHE SHALL HAVE DIRECTED
CORRESPONDENCE TO THE INSURED BY A MANNER OF SERVICE ENUMERATED IN
SECTION THREE HUNDRED EIGHT OF THE CIVIL PRACTICE LAW AND RULES.
(C) 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 LEGAL REPRESENTATIVE SHALL SUBMIT
WRITTEN PROOF OF CLAIM TO THE INSURER, INCLUDING FULL PARTICULARS OF THE
NATURE AND EXTENT OF THE INJURIES AND TREATMENT RECEIVED AND CONTEM-
PLATED, AS SOON AS REASONABLY PRACTICABLE BUT, IN NO EVENT LATER THAN
SIX MONTHS AFTER THE DATE SERVICES ARE INITIALLY RENDERED. THE ELIGIBLE
INJURED PERSON OR THAT PERSON'S LEGAL REPRESENTATIVE SHALL SUBMIT WRIT-
TEN PROOF OF CLAIM FOR WORK LOSS BENEFITS AND FOR OTHER NECESSARY
EXPENSES TO THE INSURER WITHIN SIX MONTHS AFTER THE ACCIDENT. THE FORE-
GOING TIME LIMITATIONS FOR THE SUBMISSION OF PROOF OF CLAIM SHALL APPLY
UNLESS THE ELIGIBLE INJURED PERSON OR THAT PERSON'S LEGAL REPRESENTATIVE
SUBMITS WRITTEN PROOF PROVIDING JUSTIFICATION FOR THE FAILURE TO COMPLY
WITH SUCH TIME LIMITATION WHICH IS REASONABLE BY A PREPONDERANCE OF
EVIDENCE. UPON REQUEST BY THE INSURER, 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 INSURER AND SUBSCRIBE THE SAME;
(C) PROVIDE AUTHORIZATION THAT WILL ENABLE THE INSURER TO OBTAIN
MEDICAL RECORDS; AND
(D) PROVIDE ANY OTHER PERTINENT INFORMATION THAT MAY ASSIST THE INSUR-
ER IN DETERMINING THE AMOUNT DUE AND PAYABLE.
THE ELIGIBLE INJURED PERSON SHALL SUBMIT TO MEDICAL EXAMINATION BY
PHYSICIANS SELECTED BY, OR ACCEPTABLE TO, THE INSURER, WHEN, AND AS
OFTEN AS, THE INSURER MAY REASONABLY REQUIRE.
(2) THE DEPARTMENT SHALL PROMULGATE SUCH RULES AND REGULATIONS AS ARE
NECESSARY TO IMPLEMENT THE PROVISIONS OF THIS SUBSECTION; PROVIDED,
HOWEVER, THAT SUCH RULES AND REGULATIONS SHALL NOT BE LESS FAVORABLE IN
ANY RESPECT TO ANY COVERED PERSONS, NOR SHALL ANY ADDITIONAL CONDITION
PRECEDENT FOR COVERAGE OR FILING A CLAIM BE ESTABLISHED THEREBY.
S 2. This act shall take effect on the one hundred twentieth day after
it shall have become a law; provided that any rules and regulations
necessary to implement the provisions of this act on its effective date
are authorized and directed to be promulgated and shall become effective
on such date.