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This entry was published on 2017-06-30
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SECTION 5102
Definitions
Insurance (ISC) CHAPTER 28, ARTICLE 51
§ 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; (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;
significant limitation of use of a body function or system; or a
medically determined injury or impairment of a non-permanent nature
which prevents the injured person from performing substantially all of
the material acts which constitute such person's usual and customary
daily activities for not less than ninety days during the one hundred
eighty days immediately following the occurrence of the injury or
impairment.

(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.