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This entry was published on 2017-06-30
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SECTION 5103
Entitlement to first party benefits; additional financial security required
Insurance (ISC) CHAPTER 28, ARTICLE 51
§ 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.

(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.