2023 New York Laws › ISC - Insurance › Article 51 - Comprehensive Motor Vehicle Insurance Reparations › 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.