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§ 65-1.1PART 65(Regulation 68)REGULATIONS IMPLEMENTING THE COMPREHENSIVE MOTORVEHICLE INSURANCE REPARATIONS ACTEditor’s Note: The former No-Fault regulation was repealed effective April5, 2002. It is therefore no longer included in the offcial NewYork Codes, Rules and Regulations. However, because theremay still be claims or claim procedures which remain coveredby the old regulation, the New York State Insurance Department is making a copy of this regulation available for historical reference at the Insurance Department’s website at http://www.dfs.ny.gov/insurance/r68 old.htm. Questions as towhether specifc claims and claims procedures are subject tothe old or new No-Fault regulations are clarifed under theFAQ section for No-Fault at ory authority: Insurance Law, §§ 201, 301, 2307, 2601, 5103, 5106, 5109, 5221,arts. 4, 51; Vehicle and Traffc Law, § 2407; Financial Services Law, § 202, arts. 3, 4)Historical NotePart (§§ 65.1-65.9) fled Oct. 3, 1973; amd. fled Aug. 30, 1985 eff. Sept. 1, 1985. AmendedPart title and statutory authority. Part 65 fled Oct. 18, 1999, declared invalid, null and void onJune 9, 2000 in Medical Society of New York v. Neil D. Levin as Superintendent of Insurance,712 NY2d 745 (Supreme Court, New York County). Amendments to such Part fled Jan. 31,2000 as emergency measure eff. Jan. 31, 2000; fled April 26, 2000 as emergency measure eff.Jan. 31, 2000; fled July 24, 2000 as emergency measure eff. July 24, 2000; fled Oct. 19, 2000as emergency measure eff. Oct. 19, 2000; amd. fled Jan. 8, 2001 as emergency measure eff.Jan. 8, 2001, invalid, null and void by operation of Medical Society of New York, Id. FormerPart 65 as extant prior to Nov. 1, 1999, continued effective from Oct. 31, 1999; Part (Regulations Implementing the Comprehensive Motor Vehicle Insurance Reparations Act, §§ 65.165.19) repealed, new (Subparts 65-1—65-4) fled Aug. 2, 2001 eff. Sept. 1, 2001. Effectiveness stayed Aug. 29, 2001; stay overruled April 4, 2002, Part effective April 5, 2002.SUBPART 65-1(Regulation 68-A)PRESCRIBED POLICY ENDORSEMENTSHistorical NoteSubpart (§§ 65-1.1—65-1.8) fled Aug. 2, 2001 eff. Sept. 1, 2001.§ 65-1.1 Requirements for minimum beneft insurance policies for personal injuries.(a) Every owner’s policy of liability insurance issued in satisfaction of the minimum requirements of article 6 or 8 of the Vehicle and Traffc Law and article 51 of the Insurance Law andevery policy issued in satisfaction of the minimum requirements of article 44-B of the Vehicleand Traffc Law shall contain provisions providing minimum frst-party benefts equal to thoseset out below in the mandatory personal injury protection endorsement (New York), or mandatory personal injury protection endorsement - motorcycles (New York), respectively.(b) An insurer shall provide the appropriate endorsement to be used with a policy. The Mandatory Personal Injury Protection Endorsement (New York) and the Mandatory Personal InjuryProtection Endorsement - Motorcycles (New York) set out below are approved and promulgatedfor use by an insurer. Except as provided in subdivision (c) of this section and section 65-1.7 ofthis Subpart, an insurer shall provide:(1) the Mandatory Personal Injury Protection Endorsement (New York) to every insuredwith respect to a policy issued, renewed, modifed, altered or amended on or after January 26,2011; or(2) the Mandatory Personal Injury Protection Endorsement - Motorcycles (New York) toevery insured with respect to a motorcycle policy issued or renewed.--1
§ 65-1.1(c) The mandatory personal injury protection endorsement - all-terrain vehicles (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 issued with every liability policy covering an all-terrain vehicle as required by section 2407 of article 48-C of the New York Vehicle and Traffc Law andSubpart 64-2 of this Title and must be:(1) furnished to all new insureds with policies effective on and after September 1, 2001;and(2) enclosed with the frst renewal policies renewed on and after September 1, 2001.(d) Mandatory personal injury protection endorsement.MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT(New York)The Company agrees with the named insured, as follows:Section IMandatory Personal Injury ProtectionThe company will pay frst-party benefts to reimburse for basic economic loss sustained by aneligible injured person on account of personal injuries caused by an accident arising out of the use oroperation of a motor vehicle or a motorcycle during the policy period and within the United States ofAmerica, its territories or possessions, or Canada.1First-Party BeneftsFirst-party benefts, other than death benefts, are payments equal to basic economic loss, reducedby the following:(a)20 percent of the eligible injured person’s loss of earnings from work to the extent that aneligible injured person’s basic economic loss consists of such loss of earnings;(b)amounts recovered or recoverable on account of personal injury to an eligible injured personunder State or Federal laws providing social security disability or workers’ compensationbenefts, or disability benefts under article 9 of the New York Workers’ Compensation Law;(c)the amount of any applicable deductible, provided that such deductible shall apply to eachaccident, but only to the total of frst-party benefts otherwise payable to the named insuredand any relative as a result of that accident.Basic Economic LossBasic economic loss shall consist of medical expense, work loss, other expense and, when deathoccurs, a death beneft as herein provided. Except for such death beneft, basic economic loss shall notinclude any loss sustained on account of death. Basic economic loss of each eligible injured person onaccount of any single accident shall not exceed 50,000, except that any death beneft hereunder shallbe in addition thereto.Medical ExpenseMedical expense shall consist of necessary expenses for:(a)medical, hospital (including services rendered in compliance with Article 41 of the PublicHealth Law, whether or not such services are rendered directly by a hospital), surgical,nursing, dental, ambulance, X-ray, prescription drug and prosthetic services;(b)psychiatric, physical and occupational therapy and rehabilitation;(c)any nonmedical remedial care and treatment rendered in accordance with a religious methodof healing recognized by the laws of New York; and1If the policy is being used to satisfy the fnancial responsibility requirements of article 44-B of the Vehicle and TraffcLaw, then the Company may substitute the following language:The company will pay frst-party benefts to reimburse for basic economic loss sustained by an eligible injured person on account of personal injuries caused by an accident arising out of the use or operation of a motor vehicle, pursuant to article44-B of the Vehicle and Traffc Law, by a transportation network company driver during the policy period and within theUnited States of America, its territories or possessions, or Canada.2--
§ 65-1.1(d)any other professional health services.These medical expenses will not be subject to a time limitation, provided that, within one year afterthe date of the accident, it is ascertainable that further medical expenses may be sustained as a resultof the injury. Payments hereunder for necessary medical expenses shall be subject to the limitationsand requirements of section 5108 of the New York Insurance Law.Work LossWork loss shall consist of the sum of the following losses and expenses, up to a maximum paymentof 2,000 per month for a maximum period of three years from the date of the accident:(a)loss of earnings from work which the eligible injured person would have performed had suchperson not been injured, except that an employee who is entitled to receive monetarypayments, pursuant to statute or contract with the employer, or who receives voluntarymonetary benefts paid for by the employer, by reason of such employee’s inability to workbecause of personal injury arising out of the use or operation of a motor vehicle or amotorcycle, shall not be entitled to receive frst-party benefts for loss of earnings from workto the extent that such monetary payments or benefts from the employer do not result in theemployee suffering a reduction in income or a reduction in such employee’s level of futurebenefts arising from a subsequent illness or injury; and(b)reasonable and necessary expenses sustained by the eligible injured person in obtainingservices in lieu of those which such person would have performed for income.Other ExpensesOther expenses shall consist of all reasonable and necessary expenses, other than medical expenseand work loss, up to 25 per day for a period of one year from the date of the accident causing injury.Death BeneftUpon the death of any eligible injured person, caused by an accident to which this coverageapplies, the Company will pay to the estate of such person a death beneft of 2,000.Eligible Injured PersonSubject to the exclusions and conditions set forth below, an eligible injured person is:(a)the named insured and any relative who sustains personal injury arising out of the use oroperation of any motor vehicle;(b)the named insured and any relative who sustains personal injury arising out of the use oroperation of any motorcycle, while not occupying a motorcycle;(c)any other person who sustains personal injury arising out of the use or operation of theinsured motor vehicle in the State of New York while not occupying another motor vehicle;or(d)any New York State resident who sustains personal injury arising out of the use or operationof the insured motor vehicle outside of New York while not occupying another motor vehicle.ExclusionsThis coverage does not apply to personal injury sustained by:--(a)the named insured while occupying, or while a pedestrian through being struck by, any motorvehicle owned by the named insured with respect to which the coverage required by the NewYork Comprehensive Motor Vehicle Insurance Reparations Act is not in effect;(b)any relative while occupying, or while a pedestrian through being struck by, any motorvehicle owned by the relative with respect to which the coverage required by the New YorkComprehensive Motor Vehicle Insurance Reparations Act is not in effect;(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 towhich the coverage required by the New York Comprehensive Motor Vehicle InsuranceReparations Act is in effect; however, this exclusion does not apply to personal injurysustained in New York State by the named insured or relative while occupying a bus orschool bus, as defned in sections 104 and 142 of the New York Vehicle and Traffc Law,unless that person is the operator, an owner, or an employee of the owner or operator, of suchbus or school bus;3
§ 65-1.1[(d)any person in New York State while occupying the insured motor vehicle which is a bus orschool bus, as defned in sections 104 and 142 of the New York Vehicle and Traffc Law, butonly if such person is a named insured or relative under any other policy providing thecoverage required by the New York Comprehensive Motor Vehicle Insurance ReparationsAct; however, this exclusion does not apply to the operator, an owner, or an employee of theowner or operator, of such bus or school bus;] 2(e)any person while occupying a motorcycle;(f)any person who intentionally causes his or her own personal injury; 3(g)any person as a result of operating a motor vehicle while in an intoxicated condition or whilehis or her ability to operate the vehicle is impaired by the use of a drug (within the meaningof section 1192 of the New York Vehicle and Traffc Law), except that coverage shall applyto necessary emergency health services rendered in a general hospital, as defned in section2801(10) of the New York Public Health Law, including ambulance services attendant theretoand related medical screening. However, where the person has been convicted of violatingsection 1192 of the New York Vehicle and Traffc Law while operating a motor vehicle in anintoxicated condition or while his or her ability to operate such vehicle is impaired by the useof a drug, and the conviction is a fnal determination, the company has a cause of actionagainst such person for the amount of frst party benefts that are paid or payable; 4(h)any person while:(1)committing an act which would constitute a felony, or seeking to avoid lawfulapprehension or arrest by a law enforcement offcer; 3(2)operating a motor vehicle in a race or speed test; 3(3)operating or occupying a motor vehicle known to that person to be stolen;3 or(4)repairing, servicing or otherwise maintaining a motor vehicle if the conduct is within thecourse of a business of repairing, servicing or otherwise maintaining a motor vehicle andthe injury occurs on the business premises; 3(i)the named insured or relative while not occupying a motor vehicle or a motorcycle whenstruck by a motorcycle in New York State with respect to which the coverage required by theNew York Comprehensive Motor Vehicle Insurance Reparations Act is in effect;(j)any New York State resident other than the named insured or relative injured through the useor operation of the insured motor vehicle outside of New York State if such resident is theowner or a relative of the owner of a motor vehicle insured under another policy providing thecoverage required by the New York Comprehensive Motor Vehicle Insurance ReparationsAct;(k)any New York State resident other than the named insured or relative injured through the useor operation of the insured motor vehicle outside of New York State if such resident is theowner of a motor vehicle for which the coverage required by the New York ComprehensiveMotor Vehicle Insurance Reparations Act is not in effect; or2Language in brackets may be deleted if the insured motor vehicle is not a bus or school bus.3 These exclusions may be deleted, in the event the Company wishes to provide coverage under the indicatedcircumstances.4This exclusion may be deleted, in the event the company wishes to provide coverage under the indicated circumstance.Alternatively, the company may delete the cause of action language only, provided, however, that, in either case, if thecompany deletes this language, then the company will be deemed to have waived its right to bring a cause of action againstthe person.4--
§ 65-1.1(l)any person who is injured while, pursuant to article 44-B of the Vehicle and Traffc Law, theinsured motor vehicle is being used or operated by a transportation network company driver.5Other DefnitionsWhen used in reference to this coverage:(a)the insured motor vehicle means a motor vehicle owned by the named insured and to whichthe bodily injury liability insurance of this policy applies and for which a specifc premium ischarged;(b)motorcycle means a vehicle as defned in section 123 of the New York Vehicle and TraffcLaw and which is required to carry fnancial security pursuant to article 6, 8 or 48-A of theVehicle and Traffc Law;(c)motor vehicle means a motor vehicle, as defned in section 311 of the New York Vehicle andTraffc Law, and also includes fre and police vehicles, but shall not include any motorvehicle not required to carry fnancial security pursuant to article 6, 8 or 48-A of the Vehicleand Traffc Law, or a motorcycle as defned above;(d)named insured means the person or organization named [in the declarations]; 6(e)occupying means in or upon or entering into or alighting from;(f)personal injury means bodily injury, sickness or disease;(g)relative means a spouse, child, or other person related to the named insured by blood,marriage, or adoption (including a ward or foster child), who regularly resides in theinsured’s household, including any such person who regularly resides in the household, but istemporarily living elsewhere; and(h)use or operation of a motor vehicle or a motorcycle includes the loading or unloading of suchvehicle.ConditionsAction Against Company. No action shall lie against the Company unless, as a condition precedentthereto, there shall have been full compliance with the terms of this coverage.Notice. In the event of an accident, written notice setting forth details suffcient to identify theeligible injured person, along with reasonably obtainable information regarding the time, place andcircumstances of the accident, shall be given by, or on behalf of, each eligible injured person, to theCompany, or any of the Company’s authorized agents, as soon as reasonably practicable, but in noevent more than 30 days after the date of the accident, unless the eligible injured person submitswritten proof providing clear and reasonable justifcation for the failure to comply with such timelimitation. If an eligible injured person or that person’s legal representative institutes a proceeding torecover damages for personal injury under section 5104(b) of the New York Insurance Law, a copy ofthe summons and complaint or other process served in connection with such action shall be forwardedas soon as practicable to the Company or any of the Company’s authorized agents by such eligibleinjured person or that person’s legal representative.Proof of Claim. Medical, Work Loss, and Other Necessary Expenses. In the case of a claim forhealth service expenses, the eligible injured person or that person’s assignee or representative shall5An insurer may not include this exclusion in a policy used to satisfy the requirements under article 44-B of the Vehicleand Traffc Law. An insurer may use one of the following exclusions:If the policy provides liability coverage while, pursuant to article 44-B of the Vehicle and Traffc Law, the insured motor vehicle is being used or operated by a transportation network company driver while providing a transportation networkcompany prearranged trip:any person who is injured while, pursuant to article 44-B of the Vehicle and Traffc Law, the insured motor vehicle is beingused or operated by a transportation network company driver while the driver is logged onto a transportation networkcompany’s digital network but is not engaged in a transportation network company prearranged trip.If the policy provides liability coverage while, pursuant to article 44-B of the Vehicle and Traffc Law, the insured motor vehicle is being used or operated by a transportation network company driver while logged onto a transportation networkcompany’s digital network but who is not engaged in a transportation network company prearranged trip:any person who is injured while, pursuant to article 44-B of the Vehicle and Traffc Law, the insured motor vehicle is beingused or operated by a transportation network company driver, while the driver provides a transportation network companyprearranged trip.6Companies may substitute the appropriate term, reference or language for the matter set out in brackets. With respect toa group policy issued pursuant to Insurance Law section 3455, the named insured includes transportation network driver towhom a certifcate of insurance is issued under the group policy.--5
§ 65-1.1submit written proof of claim to the Company, including full particulars of the nature and extent ofthe injuries and treatment received and contemplated, as soon as reasonably practicable but, in noevent later than 45 days after the date services are rendered. The eligible injured person or thatperson’s representative shall submit written proof of claim for work loss benefts and for othernecessary expenses to the Company as soon as reasonably practicable but, in no event, later than 90days after the work loss is incurred or the other necessary services are rendered. The foregoing timelimitations for the submission of proof o
5, 2002. It is therefore no longer included in the offcial New York Codes, Rules and Regulations. However, because there may still be claims or claim procedures which remain covered by the old regulation, the Ne
