New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 65 - Regulations Implementing The Comprehensive Motor Vehicle Insurance Reparations Act › Subpart 65-1 - Prescribed Policy Endorsements › Section 65-1.2 - Requirements for optional basic economic loss coverage

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The Optional Basic Economic Loss Coverage
					 Endorsement (New York), set out below is approved and promulgated for use by an
					 insurer and, except as provided in section
					 65-1.7  of
					 this Subpart, must be furnished to all insureds who purchase Optional Basic
					 Economic Loss (OBEL) coverage.
OPTIONAL BASIC ECONOMIC LOSS COVERAGE ENDORSEMENT
(New York)
The Company agrees with the named insured, subject to all
						of the provisions, exclusions and conditions of the MANDATORY PERSONAL INJURY
						PROTECTION ENDORSEMENT (New York) not expressly modified in this Endorsement,
						as follows:
The definition of Basic Economic Loss contained in the
						MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT (New York) or the MANDATORY
						PERSONAL INJURY PROTECTION ENDORSEMENT-MOTORCYCLES (New York) is replaced by
						the following:
Basic Economic Loss:
Basic economic loss shall consist of medical expense,
						work loss, other expense and, when death occurs, a death benefit as herein
						provided. Except for such death benefit, basic economic loss shall not include
						any loss sustained on account of death. Basic economic loss of each eligible
						injured person on account of any single accident shall not exceed $75,000, the
						last $25,000 of which represents optional basic economic loss coverage, payable
						after the first $50,000 of basic economic loss has been exhausted, that the
						eligible injured person or that person's legal representative may specify will
						be applied to one of the following four options:
(a) basic economic loss;
(b) loss of earnings from work;
(c) Psychiatric, physical or occupational therapy and
						rehabilitation; or
Any death benefit hereunder shall be in addition
						thereto.
Exclusion (c) set forth in the MANDATORY PERSONAL INJURY
						PROTECTION ENDORSEMENT (New York) is replaced by the following:
(c) the named insured or relative while occupying, or
						while a pedestrian through being struck by, a motor vehicle in New York State,
						other than the insured motor vehicle, with respect to which the coverage
						required by the New York Comprehensive Motor Vehicle Insurance Reparations Act
						is in effect; however, this exclusion does not apply to:
(1) the Optional Basic Economic Loss coverage provided
						under this endorsement, unless OBEL coverage is provided by the policy covering
						the other motor vehicle; or
(2) to personal injury sustained in New York State by the
						named insured or relative while occupying a bus or school bus, as defined in
						sections 104 and 142 of the New York Vehicle and Traffic Law, unless that
						person is the operator, an owner, or an employee of the owner or operator, of
						such bus or school bus.
Election
Election of the OBEL option shall be made by the eligible
						injured person or that person's legal representative after such person has
						incurred expense aggregating $30,000 in basic economic loss and after receiving
						the required notices from the Company that an OBEL election may be made.
						Failure of the eligible injured person or that person's legal representative to
						respond to the second notice within 15 calendar days after its mailing shall be
						considered an election by the eligible injured person to apply OBEL coverage to
						all elements of basic economic loss. Once made by the eligible injured person
						or that person's legal representative, an OBEL election cannot be changed.
						However, if claims payable under OBEL coverage have not yet been received by
						the Company, an eligible injured person who has failed to respond to the second
						notice in a timely manner may make an election.
Notice
If OBEL coverage is payable under this policy, but
						Mandatory PIP is being paid under a policy covering another motor vehicle, then
						the named insured or relative shall notify the Company no later than 90 days
						after Mandatory PIP benefits under that other policy have been exhausted. The
						Company shall then send its OBEL election notice.
(b) The insurer shall in connection with new
					 policy applications offer applicants OBEL coverage by sending the applicant the
					 following letter:
Dear Applicant:
Optional Basic Economic Loss (OBEL) coverage is being
						offered to you as an enhancement of the Basic No-Fault coverage you are
						presently required to purchase. But before we describe this coverage, we would
						like to advise you what benefits Basic No-Fault coverage does and does not
						provide.
No-Fault coverage, otherwise known as Personal Injury
						Protection or "PIP" coverage, pays for expenses incurred by persons injured in
						a motor vehicle accident. This coverage does not pay to repair damage to your
						automobile.
Basic No-Fault, which you are required by law to
						purchase, provides coverage of up to $50,000 per person in benefits for:
1. all necessary doctor and hospital bills and other
						health service expenses, payable in accordance with fee schedules established
						or adopted by the New York State Insurance Department; and
2. 80% of lost earnings up to a maximum monthly payment
						of $2,000 for up to three years following the date of accident; and
3. up to $25 per day for a period of one year from the
						date of the accident for other reasonable and necessary expenses the injured
						person may have incurred because of an injury resulting from the accident, such
						as the cost of hiring a housekeeper or necessary transportation expenses to and
						from a health service provider; and
4. a $2,000 death benefit, payable to the estate of a
						covered person, in addition to the $50,000 coverage for economic loss described
						above.
No-Fault benefits will be reduced by other benefits that
						are payable under Workers' Compensation, Social Security Disability, New York
						State Disability, and certain employer "wage continuation" plans where an
						employee does not lose any future sick leave benefits. [In addition to the
						basic No-Fault coverage described, higher limits of up to ___________,
						including payments of up to __________ for loss of earnings and up to
						___________ for other reasonable and necessary expenses, are available for
						purchase upon request.] [FN13]
OPTIONAL COVERAGE AVAILABLE
In addition to Basic No-Fault Coverage, you may also
						purchase OBEL coverage that will pay certain expenses, up to $25,000, above the
						Basic No-Fault limit of $50,000. OBEL coverage is different from other
						coverages in that a claimant can select the kinds of benefits to be paid under
						OBEL.
If you purchase OBEL coverage and if it appears likely
						that a claimant will use up the Basic No-Fault coverage, your insurer will send
						the claimant a form for the claimant to choose what expenses the $25,000 in
						OBEL coverage will be used to pay. Under No-Fault, a claimant could include
						you, family members, passengers in your car, or pedestrians, if injured in an
						auto accident.
The claimant will be able to choose one of the following
						four OBEL options and thereby direct the insurer to pay expenses for:
1. basic economic loss, whether health care expenses,
						loss of earnings from work, or other reasonable and necessary expenses;
2. loss of earnings from work;
3. psychiatric, physical or occupational therapy and
						rehabilitation; or
4. a combination of options 2 and 3.
The additional $25,000 of OBEL coverage will be used only
						for costs incurred under the chosen option, which, once selected, the claimant
						cannot change.
If you have any questions, please contact your Company or
						agent.
[FN13] This Additional PIP language may be deleted at the
						insurer's option.