The Law Offices of Robert J. White

New York No-fault Law

§5:12 Four Categories of Loss
Under New York's No-fault law, there are four categories of damages that a plaintiff may incur. The first three are compensated in most cases by the host car carrier, and are collectable regardless of fault, provided that the plaintiff was not in the process of committing a felony and the injury was occasioned due to operation and control of a motor vehicle. The fourth is only collectable against a third party defendant if negligence and culpable conduct
are established. The four types of damages are:
Basic economic loss", also called: "First-part benefits" (Ins. L.§5102(a),(b)) [§5:12.10].
Death benefit of $2,000) (Ins. L. §§5102(a)(4), 5103(a)(4» [§5:12.20]
Economic damages exceeding basic economic loss (Ins. L.§5102) [§5:12.30]

Non-economic loss (Ins. L. §5102))[§5:12.40]

Note: All New York motor vehicle insurance policies are required to carry basic PIP with limits 01$50,000, but additional PIP coverage may be purchased for up to $1OO.00O. Know what limits are available on the vehicle in question. And, as of Sept.1, 1998, all. Taxicabs in New York City are required to carry PIP with limits of $200,000.
§5:12.10 Basic Economic Loss (First-party Benefits)
Basic economic loss is defined in Art. 51, Insurance Law §5101 (a)(1)(2) & (3). Section
5101 (a)(l) outlines the categories of medical expenses that are compensable under the No-fault law. while §5101~(a)(2) provides for the reimbursement of lost wages. Section (a)(3)
also provides for, ""all other reasonable and necessary expenses incurred up to twenty-five ($25) per day for not more than one year from the date of the accident causing the injury.” Section (a)(3) is often used to claim transportation expenses.
Basic economic loss is up to a total aggregate of $50,000 per victim for the following losses resulting from the accident (Ins. L. §5102(a)):
Health expenses
Lost earnings up to $2000 per month, for up to 3 years
Other “out of pocket” expenses (e.g., housekeeping) up to $25 per day for up to 1 year
The payment to reimburse the victim economic loss, a form of first-party benefits will be reduced by offsets reflecting:

· Income taxes the claimant does not pay on No-fault payments compensating for lost earnings

Collateral payments, such as workers’ compensation, the claimant receives on account of the accident

Allowable insurance policy deductibles See Ins.L 5102(b ).

Unless the insurance contract provides for additional coverage, first-party benefits are subject to a ceiling of $50,000.
See Ins. L. 5102(a)(1)-(5)
Practice tip: It is a good idea to advise all clients and friends to purchase extended No-fault benefits that will cover them if they are injured in their own vehicle. This extended coverage maintained by any host vehical in which they are riding when injured. These policies are comparatively inexpensive and are often not mentioned by brokers, as the commission on their sale is small.
§5:12.20 Death Benefits
This represents payment of reasonable funeral expenses, including travel and other items. This benefit is in addition to any first-party benefis avictim may be entitled to up to the time of his death, such as the ambulance costs and emergency room costs. {Ins.L 5102(a)(4), 5103(a)(4)}.
§15:12.30 Economic Damages Exceeding Basic Economic Loss
Economic damages exceeding basic economic loss include items that exceed the coverage provide by the No-fault carrier. [Ins. L5102] For example:

Accident injury prevented the victim from working for more than three years

Accident prevented the victim from working. and the victim's earnings were more than $2,000 per month

512.40 Non-economic Losses
Non-economic losses generally include items such as:

Conscious pain and suffering

Loss of consortium

Ability to enjoy life

Emotional distress

Ins. L. §5102(c).
§5:20 Who Is Covered
As an initial matter only certain persons are eligible for No-fault coverage. Eligible injured persons are defined as:
(a) the named insured and any relative who sustains personal injury arising
out of the use or operation of any motor vehicle;
(b) the named insured and any relative who sustains personal injury arising
out of the use or operation of any motor vehicle. while not occupying a motorcycle;
( c ) the named insured and any relative who sustains personal injury arising
out of the use or operation of the insured 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 operation of the insured motor vehicle outside of New York while not
occupying another motor vehicle.
11 NYCRR 65.12: Mandatory Personal Injury Protection Endorsement. Also, see the
applicable exclusions in that section. For more detail on who is covered.
see §9:10.
§5:30 "Use and Operation of a Motor Vehicle"
Any injury must arise from the “use or operation of a motor vehicle.”. Ins. L. 5102.
“Use or operation of a motor vehicle,” is defined by William Walton v Lumbennan's Mutual Casualty Co., 88 NY2d 211, 644 N.Y.S2d 133 (1996) as an accident that:

Arose out of inherent nature of the automobile

Arose within the natural territorial limits of auto & accidental use, loading, or unloading must not have ended , i.e., exiting vehicle and unloading was one continuous act or process, and

Automobile itself produced the injury.

For more on standards of operation and control, see 20III
§5:40 Two-Track Recovery System
To compensate auto accident victims, the No-fault law establishes a two-track system:
The insurance claim and the civil action.

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Robert J. White
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