Yesterday morning, I presented a webinar titled 10 Things You Didn't Know About New York No-Fault (check the Education section of the IIABNY Web site occasionally to see when the archived recording will be available). More than 80 people attended the session online, and several of them asked a lot of good questions. Among those questions were a couple that I didn't feel comfortable answering without doing a little research. My memory is a dangerous thing, and if I rely on it, my risk of spreading misinformation rises dramatically. Having taken some time now to research these questions, I'm prepared to give you accurate answers, so here goes:
Q: if there is a NY out of state endorsement on the policy, then does it not EXTEND the NY coverage to anyone in your car out of State?
A: I'm not familiar with a New York "out of state" endorsement. However, the Additional Personal Injury Protection Coverage — New York endorsement (ISO form number PP 05 88 01 11 for personal auto; CA 22 33 01 11 for commercial auto) changes the definition of "eligible injured person." The basic PIP endorsement defines the term in part as including:
(A)ny ... person (other than the named insured or 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...
This was the basis for my statement that my friend in North Carolina would be covered under my No-Fault insurance if he was riding in my car in New York but would not be if he was riding in my car in North Carolina. The additional PIP endorsement changes this to state:
(A)ny ... person (other than the named insured or relative) who sustains personal injury arising out of the use or operation of the insured motor vehicle while occupying the insured motor vehicle...
Further, it adds this to the definition:
(A)ny ... person (other than the named insured or relative) who sustains personal injury arising out of the use or operation of any other motor vehicle (other than a public or livery conveyance) while occupying such other motor vehicle, if such other motor vehicle is being operated by the named insured or any relative.
Therefore, the Additional PIP endorsement removes any requirement for the accident to occur in New York State. If I have this endorsement on my policy (incidentally, I do,) then my friend P.G. has New York No-Fault coverage while he's riding in my car anywhere in the U.S. and Canada, and he has coverage while he's riding in any car I'm driving in the U.S. and Canada. Whether that makes him any more likely to get in a car with me is an open question...
This one relates to one of my areas of interest — health insurance (by the way, the Health Care Reform Primer will return when I get some blocks of time to do a good job of analysis.) Here's the question:
Q: is there any medical coverages for injuries sustained in an auto accident from health insurance plans, especially if someone exceeds basic PIP and Additional PIP?
A: Both PIP endorsements define "first-party benefits" as payments equal to "basic economic loss", reduced by:
- 20 percent of the eligible injured person's loss of earnings from work
- Social Security disability, Workers' Compensation, and/or New York State disability benefits
- Any applicable deductible
This implies that No-Fault is primary over any other benefits. Consequently, if an injured person has health insurance, the medical expense portion of No-Fault will pay first, up to the limit of insurance, then health insurance might apply. I say "might" because New York Insurance Regulation 62 permits a health insurer to exclude coverage when No-Fault benefits are recoverable. If such an exclusion is on the policy, the injured person's sole source of recovery will be No-Fault.
If anyone has additional questions from the webinar, post 'em in the comments and I'll answer them as soon as I can. Thanks again for attending!
Tim: Thanks for the response. I called it out of state when it should have been called APIP. There are different levels of APIP also.My experience with Hospitalization is that it is excess over PIP. They can exclude coverage to the extent that PIP is recoverable then they have to step up.The 20% reduction for loss of earnings is because the benefit is tax free, I believe. Bruce Teague
Posted by: Bruce Teague | September 23, 2011 at 01:11 PM
Hi, Tim. Great webinar yesterday- as are all of yours! We are trying to fully understand why an insured needs medical payments coverage and PIP coverage in NY if they NEVER have a 3rd party in their vehicle (only employees). The medical payments coverage form seems to provide coverage for first and third party benefits, but if the insured has PIP, why would they need medical payments? Thank you in advance for your help.
Posted by: Jennifer Watson | September 23, 2011 at 01:56 PM
Bruce,
Thanks for sharing. This blog works best when the readers chip in with their expertise!
Posted by: Tim Dodge | September 23, 2011 at 02:04 PM
Thanks for the excellent webinar! I'll have to give a presentation to my office now with all this useful information. So, maybe I take that back... LOL j/k!!
Posted by: Elizabeth DiGiovanna | September 26, 2011 at 06:05 AM
Jennifer,
Thank you for attending the webinar. A business in this situation that has PIP coverage probably does not need Medical Payments Coverage. If the named insured is a business (i.e., not an individual,) then first-party benefits are pretty much non-existent, since businesses don't suffer bodily injury and have no relatives. Employees have no coverage under Medical Payments because Workers' Compensation applies to their injuries. If the business never has anyone other than employees in the vehicles, they can skip out on buying Medical Payments without having to worry about a coverage gap.
Posted by: Tim Dodge | September 26, 2011 at 11:18 AM
Elizabeth,
Thank you for attending the Webinar! I hope it helps you with your presentation.
Posted by: Tim Dodge | September 26, 2011 at 11:20 AM
Hi, when is the next webinar, I would love to attend, especially after reading through all the positive responses above.
Posted by: ellie | October 17, 2011 at 12:13 PM
Ellie,
I'll be doing a webinar on Workers Compensation next winter. We have it tentatively scheduled for early March. I hope you can attend!
Posted by: Tim Dodge | October 20, 2011 at 02:05 PM