Preview
FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023
NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/24/2023
FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023
NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/24/2023
FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023
NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/24/2023
FILED: QUEENS 9611A
COUNTY INDEX NO. 706270/2023
NY 0717 CLERK 03/24/2023 08:24 A
NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/24/2023
NEW YORK
AUTO POLICY
Form 9611A NY (07/17)
version 2.0
INDEX NO. 706270/2023
FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A
NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/24/2023
INDEX NO. 706270/2023
FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A
NYSCEF DOC. NO. 4 CONTENTS
RECEIVED NYSCEF: 03/24/2023
INSURING AGREEMENT...................................................................................1
GENERAL DEFINITIONS...................................................................................1
PART I—LIABILITY TO OTHERS
Insuring Agreement.......................................................................................4
Additional Definition......................................................................................4
Additional Payments......................................................................................4
Exclusions.....................................................................................................5
Limits of Liability............................................................................................6
Financial Responsibility Laws.......................................................................7
Other Insurance............................................................................................8
Out-of-State Coverage..................................................................................8
PART II(A)—PERSONAL INJURY PROTECTION COVERAGE
Mandatory Personal Injury Protection Endorsement (New York)...................8
Optional Basic Economic Loss Coverage Endorsement (New York)........... 15
Additional Personal Injury Protection Endorsement (New York).................. 16
PART II(B)—MEDICAL PAYMENTS COVERAGE
Insuring Agreement..................................................................................... 19
Additional Definitions...................................................................................20
Exclusions...................................................................................................20
Limits of Liability..........................................................................................21
Unreasonable or Unnecessary Medical Expenses.....................................22
Other Insurance..........................................................................................22
PART III—UNINSURED MOTORISTS COVERAGE
Uninsured Motorists Endorsement..............................................................22
Supplementary Uninsured/Underinsured Motorists Endorsement..............29
PART IV—DAMAGE TO A VEHICLE
Insuring Agreement—Collision Coverage...................................................35
Insuring Agreement—Comprehensive Coverage........................................35
Insuring Agreement—Additional Custom Parts or Equipment Coverage.........36
Insuring Agreement—Rental Reimbursement Coverage.............................36
Insuring Agreement—Pet Injury Coverage..................................................37
Additional Definitions...................................................................................37
Exclusions...................................................................................................38
Limits of Liability..........................................................................................39
Waiver of Collision Deductible.....................................................................41
Recovery of Stolen or Abandoned Vehicles................................................41
Payment of Loss.........................................................................................41
Mandatory Inspection..................................................................................41
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AutoDOC.
NYSCEF Repairs.
NO................................................................................................41
4 RECEIVED NYSCEF: 03/24/2023
No Benefit to Bailee....................................................................................42
Loss Payable Clause...................................................................................42
Other Sources of Recovery.........................................................................42
Appraisal.....................................................................................................42
PART V—ROADSIDE ASSISTANCE COVERAGE
Insuring Agreement.....................................................................................43
Unauthorized Service Provider...................................................................43
Additional Definitions...................................................................................43
Exclusions...................................................................................................44
Other Insurance..........................................................................................44
PART VI—DUTIES IN CASE OF AN ACCIDENT OR LOSS.............................44
PART VII—GENERAL PROVISIONS
Policy Period and Territory...........................................................................46
Changes......................................................................................................46
Duty to Report Changes.............................................................................47
Settlement of Claims...................................................................................47
Terms of Policy Conformed to Statutes.......................................................47
Transfer of Interest......................................................................................47
Fraud or Misrepresentation.........................................................................47
Payment of Premium and Fees...................................................................48
Cancellation................................................................................................48
Cancellation Refund....................................................................................49
Nonrenewal.................................................................................................50
Payment or Performance............................................................................50
Legal Action Against Us..............................................................................50
Our Rights to Recover Payment..................................................................50
Joint and Individual Interests.......................................................................51
Bankruptcy..................................................................................................51
RENTAL VEHICLE COVERAGE ENDORSEMENT..........................................51
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NYSCEF DOC. NO. 4 NEW YORK AUTORECEIVED
POLICY NYSCEF: 03/24/2023
INSURING AGREEMENT
In return for your payment of the premium, we agree to insure you subject to all the
terms, conditions and limitations of this policy. We will insure you for the coverages
and the limits of liability shown on this policy’s declarations page. Your policy consists
of the policy contract, your insurance application, the declarations page, and all en-
dorsements to this policy.
GENERAL DEFINITIONS
The following definitions apply throughout the policy. Defined terms are printed in bold-
face type and have the same meaning whether in the singular, plural, or any other form.
1. “Additional auto” means an auto you become the owner of during the policy pe-
riod that does not permanently replace an auto shown on the declarations page if:
a. we insure all other autos you own;
b. the additional auto is not covered by any other insurance policy;
c. you notify us within 30 days of becoming the owner of the additional auto;
and
d. you pay any additional premium due.
An additional auto will have the broadest coverage we provide for any auto shown
on the declarations page. If you ask us to insure an additional auto more than
30 days after you become the owner, any coverage we provide will begin at the
time you request coverage.
2. “Auto” means a land motor vehicle:
a. of the private passenger, pickup body, or cargo van type;
b. designed for operation principally upon public roads;
c. with at least four wheels; and
d. with a gross vehicle weight rating of 12,000 pounds or less, according to the
manufacturer’s specifications.
However, “auto” does not include step-vans, parcel delivery vans, or cargo cutaway
vans or other vans with cabs separate from the cargo area.
3. “Auto business” means the business of selling, leasing, repairing, parking, storing,
servicing, delivering or testing vehicles.
4. “Bodily injury” means bodily harm, sickness, or disease, including death that re-
sults from bodily harm, sickness, or disease.
5. “Covered auto” means:
a. any auto or trailer shown on the declarations page for the coverages ap-
plicable to that auto or trailer, provided such auto or trailer is predominantly
used for non-business purposes.
b. any additional auto;
c. any replacement auto; or
d. a trailer owned by you.
6. “Declarations page” means the document showing your coverages, limits of li-
ability, covered autos, premium, and other policy-related information. The declara-
tions page may also be referred to as the Auto Insurance Coverage Summary.
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7. “Digital
NYSCEF DOC.network”
NO. 4means any system or service offered or
RECEIVED a transpor-
utilized by03/24/2023
NYSCEF:
tation network company that enables TNC prearranged trips with transporta-
tion network company drivers.
8. “Occupying” means in, on, entering or exiting.
9. “Property damage” means physical damage to, destruction of, or loss of use of,
tangible property.
10. “Rated resident” means a person residing in the same household as you at the
time of the loss who is not a relative, but only if that person is both:
a. listed in the “Drivers and household residents” section on the declarations
page; and
b. not designated as a “List Only” driver.
11. “Relative” means a person residing in the same household as you, and related to
you by blood, marriage or adoption, and includes a ward, stepchild, or foster child.
Your unmarried dependent children temporarily away from home will qualify as a
relative if they intend to continue to reside in your household.
12. “Replacement auto” means an auto that permanently replaces an auto shown
on the declarations page. A replacement auto will have the same coverage as
the auto it replaces if the replacement auto is not covered by any other insurance
policy. However, if the auto being replaced had coverage under Part IV—Damage
To A Vehicle, such coverage will apply to the replacement auto only during the first
30 days after you become the owner unless you notify us within that 30-day period
that you want us to extend coverage beyond the initial 30 days. If the auto being
replaced did not have coverage under Part IV—Damage To A Vehicle, such cover-
age may be added, but the replacement auto will have no coverage under Part IV
until you notify us of the replacement auto and ask us to add the coverage.
13. “Trailer” means a non-motorized, non-commercial trailer, including a farm wagon
or farm implement, designed to be towed on public roads by an auto and not be-
ing used:
a. for commercial purposes;
b. as an office, store, or for display purposes; or
c. as a passenger conveyance.
Trailer does not include a mobile home or manufactured home.
14. “Transportation network company” or “TNC” means a person, corporation,
partnership, sole proprietorship, or other entity that is licensed pursuant to Article
44-B of the New York Vehicle and Traffic Law and is operating in New York state
exclusively using a digital network to connect transportation network compa-
ny passengers to transportation network company drivers who provide TNC
prearranged trips.
15. “Transportation network company driver” means an individual who:
a. receives connections to potential passengers and related services from a
transportation network company in exchange for payment of a fee to the
transportation network company; and
b. uses a TNC vehicle to offer or provide a TNC prearranged trip to trans-
portation network company passengers upon connection through a digital
network controlled by a transportation network company in exchange for
compensation or payment of a fee.
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16. “Transportation
NYSCEF DOC. NO. 4 network company prearranged
RECEIVED trip”NYSCEF:
means the03/24/2023
provision of
transportation by a transportation network company driver to a passenger pro-
vided through the use of a TNC’s digital network:
a. beginning when a transportation network company driver accepts a pas-
senger’s request for a trip through a digital network controlled by a trans-
portation network company;
b. continuing while the transportation network company driver transports the
requesting passenger in a TNC vehicle; and
c. ending when the last requesting passenger departs from the TNC vehicle.
The term “Transportation network company prearranged trip” does not in-
clude transportation provided through any of the following:
a. shared expense carpool or vanpool arrangements, including those as defined
in section one hundred fifty-eight-b of this chapter; and
b. use of a taxicab, livery, luxury limousine, or other for-hire vehicle, as defined in
this chapter, section 19-502 of the administrative code of the city of New York,
or as otherwise defined in local law.
17. “Transportation network company vehicle” or “TNC vehicle” means a vehicle
that is:
a. used by a transportation network company driver to provide a TNC prear-
ranged trip originating within the state of New York; and
b. owned, leased or otherwise authorized for use by the transportation net-
work company driver;
c. such term shall not include:
i. a taxicab, as defined in section one hundred forty-eight-a of this chapter
and section 19-502 of the administrative code of the city of New York, or
as otherwise defined in local law;
ii. a livery vehicle, as defined in section one hundred twenty-one-e of this
chapter, or as otherwise defined in local law;
iii. a black car, limousine, or luxury limousine, as defined in section 19-502
of the administrative code of the city of New York, or as otherwise defined
in local law;
iv. a for-hire vehicle, as defined in section 19-502 of the administrative code
of the city of New York, or as otherwise defined in local law;
v. a bus, as defined in section one hundred four of this chapter;
vi. any motor vehicle weighing more than six thousand five hundred pounds
unloaded;
vii. any motor vehicle having a seating capacity of more than seven passen-
gers; and
viii. any motor vehicle subject to section three hundred seventy of this chapter.
18. “We,” “us” and “our” mean the underwriting company providing the insurance, as
shown on the declarations page.
19. “You” and “your” mean:
a. a person shown as a named insured on the declarations page; and
b. the spouse of a named insured if residing in the same household at the time
of the loss.
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NYSCEF DOC. NO. 4 PART I—LIABILITY TO OTHERS NYSCEF: 03/24/2023
RECEIVED
INSURING AGREEMENT
If you pay the premium for this coverage, we will pay damages, other than punitive or
exemplary damages, for bodily injury and property damage for which an insured
person becomes legally responsible because of an accident.
Damages include prejudgment interest awarded against an insured person.
We will settle or defend, as we consider appropriate, any claim for damages covered
by this Part I. This applies even if the claim or suit is groundless or false.
ADDITIONAL DEFINITION
When used in this Part I:
“Insured person” means:
a. you, a relative, or a rated resident with respect to an accident arising out of the
ownership, maintenance or use of a trailer shown on the declarations page or a
covered auto;
b. you or a relative with respect to an accident arising out of the ownership, mainte-
nance, or use of an auto or trailer with the permission of the owner of the vehicle
or the person in lawful possession of the vehicle;
c. any person with respect to an accident arising out of that person’s use of a cov-
ered auto with the permission of you, a relative, or a rated resident;
d. any person or organization with respect only to vicarious liability for the acts or
omissions of a person described in a., b., or c. above; and
e. any “Additional Interest” shown on the declarations page with respect only to its
liability for the acts or omissions of a person described in a., b., or c. above.
ADDITIONAL PAYMENTS
In addition to our limit of liability, we will pay for an insured person:
1. all expenses we incur, and all costs taxed against the insured person, in the
settlement of any claim or defense of any lawsuit;
2. interest accruing after entry of judgment, until we have paid, offered to pay, or
deposited in court, that portion of the judgment which does not exceed our limit
of liability. This does not apply if we have not been given notice of suit or the op-
portunity to defend an insured person;
3. the premium on any appeal bond or attachment bond required in any lawsuit we
defend. We have no duty to purchase a bond in an amount exceeding our limit of
liability, and we have no duty to apply for or furnish these bonds;
4. up to $250 for a bail bond required because of an accident resulting in bodily
injury or property damage covered under this Part I. We have no duty to apply
for or furnish this bond;
5. expenses incurred by the insured person for first aid to others at the time of the
accident; and
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6. reasonable
NYSCEF expenses,
DOC. NO. 4 including loss of earnings up to $200
RECEIVED per day,
NYSCEF: incurred at
03/24/2023
our request.
EXCLUSIONS—READ THE FOLLOWING EXCLUSIONS CAREFULLY. IF
AN EXCLUSION APPLIES, COVERAGE WILL NOT BE AFFORDED UNDER
THIS PART I.
Coverage under this Part I, including our duty to defend, will not apply to any insured
person for:
1. bodily injury or property damage arising out of the ownership, maintenance or
use of any vehicle while being used as a public or livery conveyance. This exclu-
sion does not apply to shared-expense car pools;
2. any liability assumed under any contract or agreement by you, a relative, or a
rated resident;
3. bodily injury to an employee of that insured person arising out of or within the
course of employment. This exclusion does not apply to domestic employees if
benefits are neither paid nor required to be provided under workers’ compensa-
tion, disability benefits, or similar laws;
4. bodily injury or property damage arising out of an accident involving an auto
or trailer while being maintained or used by a person while employed or engaged
in any auto business. This exclusion does not apply to you, a relative, a rated
resident, or an agent or employee of you, a relative, or a rated resident, when
using a covered auto;
5. any obligation for which the United States Government is liable under the Federal
Tort Claims Act;
6. bodily injury or property damage caused by an intentional act of that insured
person, or at the direction of that insured person;
7. property damage to any property owned by, rented to, being transported by, used
by, or in the charge of that insured person. This exclusion does not apply to a
rented residence or a rented garage;
8. property damage sustained by the spouse of an insured person. However, this
exclusion does not apply to deny coverage to a spouse if named as a third-party
defendant in a lawsuit brought by his or her spouse against another party;
9. bodily injury or property damage arising out of the ownership, maintenance or
use of any vehicle owned by you or furnished or available for your regular use,
other than a covered auto for which this coverage has been purchased;
10. bodily injury or property damage arising out of the ownership, maintenance or
use of any vehicle owned by a relative or a rated resident or furnished or avail-
able for the regular use of a relative or a rated resident, other than a covered
auto for which this coverage has been purchased. This exclusion does not apply
to your maintenance or use of such vehicle; or
11. bodily injury or property damage sustained while the vehicle is used by a trans-
portation network company driver who is logged onto the transportation net-
work company’s digital network but is not engaged in a transportation net-
work company prearranged trip or while the driver provides a transportation
network company prearranged trip.
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LIMITS OF
NYSCEF LIABILITY
DOC. NO. 4 RECEIVED NYSCEF: 03/24/2023
If your declarations page shows a split limit:
1. the amount shown for “each person” is the most we will pay for all damages due to
bodily injury to one person resulting from any one accident;
2. subject to the “each person” limit, the amount shown for “each accident” is the
most we will pay for all damages due to bodily injury sustained by two or more
persons in any one accident; and
3. the amount shown for “property damage” is the most we will pay for the total of all
property damage resulting from any one accident.
However, if your policy has bodily injury split limits of:
1. $25,000 “each person” and $50,000 “each accident” for coverage under this Part I,
as shown on the declarations page, then the split limits set forth in the paragraph
above shall not apply to bodily injury that results in death, and the following ad-
ditional coverage will apply in the event of bodily injury that results in death, to the
extent required by New York law:
a. our limit of liability for damages due to bodily injury that results in the death
of one person in any one accident is $50,000; or
b. if two or more persons sustain bodily injury that results in death, our limit of
liability for bodily injury that results in the death of two or more persons in
any one accident is $100,000; or
2. $50,000 “each person” and $100,000 “each accident” for coverage under this Part
I, as shown on the declarations page, then the split limits set forth in the para-
graphs above for bodily injury shall not apply, and our limit of liability, to the extent
required by New York law, will be as follows:
a. for any accident that causes bodily injury that results in the death of one
person, the most we will pay for all damages due to bodily injury that results
in death is $50,000;
b. if only one person sustains bodily injury that does not result in death, the limit
of liability for damages due to bodily injury to the one person is $50,000;
c. subject to the per person limit, if two or more persons sustain bodily injury
that does not result in death, the limit of liability for all damages due to bodily
injury that does not result in death is $100,000; or
d. for any accident that causes bodily injury that results in the death of two or
more persons, the most we will pay for all damages due to bodily injury that
results in death in any one accident is $100,000, and the limit of liability for all
other bodily injury that does not result in death is:
(i) $50,000 if only one person sustains bodily injury in any one accident; or
(ii) subject to the per person limit, $100,000 for two or more persons sustain-
ing bodily injury in any one accident.
The above Limits of Liability with respect to bodily injury that results in death are
subject to the following reductions:
1. in the event of the death of one person in any accident, our $50,000 limit of liability
will be reduced by any amounts paid to or on behalf of that person under this Part I;
and
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2. in the
NYSCEF eventNO.
DOC. of the4 death of two or more persons
RECEIVED accident, our
in anyNYSCEF: $100,000
03/24/2023
limit of liability will be reduced by any amounts paid to or on behalf of those per-
sons under this Part I.
The limits of liability described above for “each person” and for “one person” apply to the
total of all claims made for bodily injury to a person and all claims of others derived
from such bodily injury, including, but not limited to, loss of society, loss of compan-
ionship, loss of services, loss of consortium, and wrongful death.
The limit of liability for bodily injury that results in the death of two or more persons
in any one accident includes the total of all claims made for such bodily injury and all
claims of others derived from such bodily injury, including, but not limited to, loss of so-
ciety, loss of companionship, loss of services, loss of consortium, and wrongful death.
If the declarations page shows that “combined single limit” or “CSL” applies, the
amount shown is the most we will pay for the total of all damages resulting from any
one accident. However, without changing this limit of liability, we will comply with any
law that requires us to provide any separate limits.
The limit of liability shown on the declarations page is the most we will pay regardless
of the number of:
1. claims made;
2. covered autos;
3. insured persons;
4. lawsuits brought;
5. vehicles involved in the accident; or
6. premiums paid.
No one is entitled to duplicate payments for the same elements of damages.
Any payment to a person under this Part I will be reduced by any payment to that per-
son under Part III—Uninsured Motorists Coverage.
We will not pay under this Part I any expenses paid or payable under Part II(B)—Medical
Payments Coverage.
An auto and attached trailer are considered one auto. Therefore, the limits of liability
will not be increased for an accident involving an auto that has an attached trailer.
FINANCIAL RESPONSIBILITY LAWS
When we issue this policy as proof of financial responsibility, this policy will comply with
the law to the extent required.
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OTHER INSURANCE
NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/24/2023
If there is any other valid and collectible liability insurance or bond that applies to the
accident, we will pay only our share of the damages. Our share is the proportion that
our limit of liability bears to the total of all applicable limits. However, any insurance we
provide for a vehicle or trailer, other than a covered auto, will be excess over any other
valid and collectible insurance, self-insurance, or bond.
OUT-OF-STATE COVERAGE
If an accident to which this Part I applies occurs in any state, territory or possession
of the United States of America or any province or territory of Canada, other than the
one in which a covered auto is principally garaged, and the state, province, territory
or possession has:
1. a financial responsibility or similar law requiring limits of liability for bodily injury
or property damage higher than the limits shown on the declarations page, this
policy will provide the higher limits; or
2. a compulsory insurance or similar law requiring a non-resident to maintain insur-
ance whenever the non-resident uses an auto in that state, province, territory or
possession, this policy will provide the greater of:
a. the required minimum amounts and types of coverage; or
b. the limits of liability under this policy.
PART II(A)—PERSONAL INJURY PROTECTION COVERAGE
MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT (New York)
The Company agrees with the named insured, as follows:
Section I
Mandatory Personal Injury Protection
The company will pay first-party benefits to reimburse for basic economic loss sus-
tained by an eligible injured person on account of personal injuries caused by an ac-
cident arising out of the use or operation of a motor vehicle or a motorcycle during the
policy period and within the United States of America, its territories or possessions, or
Canada.
First-party Benefits
First-party benefits, other than death benefits, are payments equal to basic economic
loss, reduced by the following:
(a) 20 percent of the eligible injured person’s loss of earnings from work to the extent
that an eligible injured person’s basic economic loss consists of such loss of earn-
ings;
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(b) amounts
NYSCEF DOC.recovered
NO. 4 or recoverable on account of personal
RECEIVED injury to
NYSCEF: an eligible
03/24/2023
injured person under State or Federal laws providing social security disability or
workers’ compensation benefits, or disability benefits under article 9 of the New
York Workers’ Compensation Law;
(c) the amount of any applicable deductible, provided that such deductible shall apply
to each accident, but only to the total of first-party benefits otherwise payable to
the named insured and any relative as a result of that accident.
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 $50,000, except that any death benefit hereunder shall be in addition thereto.
Medical Expense
Medical expense shall consist of necessary expenses for:
(a) medical, hospital (including services rendered in compliance with article 41 of the
Public Health Law, whether or not such services are rendered directly by a hospi-
tal), 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 reli-
gious method of healing recognized by the laws of New York; and
(d) any other professional health services.
These medical expenses will not be subject to a time limitation, provided that, within
one year after the date of the accident, it is ascertainable that further medical ex-
penses may be sustained as a result of the injury. Payments hereunder for necessary
medical expenses shall be subject to the limitations and requirements of section 5108
and Regulation 83 of the New York Insurance Law.
Work Loss
Work loss shall consist of the sum of the following losses and expenses, up to a maxi-
mum payment of $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 such person not been injured, except that an employee who is entitled to re-
ceive monetary payments, pursuant to statute or contract with the employer, or
who receives voluntary monetary benefits paid for by the employer, by reason of
such employee’s inability to work because of personal injury arising out of the use
or operation of a motor vehicle or a motorcycle, shall not be entitled to receive
first-party benefits for loss of earnings from work to the extent that such monetary
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NYSCEFpayments
DOC. orNO.
benefits
4 from the employer doRECEIVED
not result inNYSCEF:
the employee suffering
03/24/2023
a reduction in income or a reduction in such employee’s level of future benefits
arising from a subsequent illness or injury; and
(b) reasonable and necessary expenses sustained by the eligible injured person in
obtaining services in lieu of those which such person would have performed for
income.
Other Expenses
Other expenses shall consist of all reasonable and necessary expenses, other than
medical expense and work loss, up to $25 per day for a period of one year from the
date of the accident causing injury.
Death Benefit
Upon the death of any eligible injured person, caused by an accident to which this cover-
age applies, the company will pay to the estate of such person a death benefit of $2,000.
Eligible Injured Person
Subject 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 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 motorcycle, while not occupying a motorcycle;
(c) any other person 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.
Exclusions
This coverage does not apply to personal injury sustained by:
(a) the named insured while occupying, or while a pedestrian through being struck
by, any motor vehicle owned by the named insured with respect to which the
coverage required by the New York Comprehensive Motor Vehicle Insurance
Reparations Act is not in effect;
(b) any relative while occupying, or while a pedestrian through being struck by, any
motor vehicle owned by the relative with respect to which the coverage required
by the New York Comprehensive 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 to which the coverage required by the New York Comprehensive
10
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FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A
NYSCEFMotor Vehicle
DOC. NO.Insurance
4 Reparations Act is RECEIVED
in effect; however, this exclusion
NYSCEF: does
03/24/2023
not apply 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;
(d) any person while occupying a motorcycle;
(e) any person who intentionally causes his or her own personal injury;
(f) any person as a result of operating a motor vehicle while in an intoxicated condi-
tion or while his or her ability to operate the vehicle is impaired by the use of a
drug (within the meaning of section 1192 of the New York Vehicle and Traffic
Law) except that coverage shall apply to necessary emergency health services
rendered in a general hospital, as defined in section 2801(10) of the New York
Public Health Law, including ambulance services attendant thereto and related
medical screening. However, where the person has been convicted of violating
section 1192 of the New York Vehicle and Traffic Law while operating a motor
vehicle in an intoxicated condition or while his or her ability to operate such vehicle
is impaired by the use of a drug, and the conviction is a final determination, the
Company has a cause of action against such person for the amount of first party
benefits that are paid or payable; or
(g) any person while:
(1) committing an act which would constitute a felony, or seeking to avoid lawful
apprehension or arrest by a law enforcement officer;
(2) operating a motor vehicle in a race or speed test;
(3) operating or occupying a motor vehicle known to that person to be stolen; or
(4) repairing, servicing or otherwise maintaining a motor vehicle if the conduct is
within the course of a business of repairing, servicing or otherwise maintain-
ing a motor vehicle and the injury occurs on the business premises;
(h) the named insured or relative while not occupying a motor vehicle or a motor-
cycle when struck by a motorcycle in New York State with respect to which the
coverage required by the New York Comprehensive Motor Vehicle Insurance
Reparations Act is in effect;
(i) any New York State resident other than the named insured or relative injured
through the use or operation of the insured motor vehicle outside of New York
State if such resident is the owner or a relative of the owner of a motor vehicle
insured under another policy providing the coverage required by the New York
Comprehensive Motor Vehicle Insurance Reparations Act;
(j) any New York State resident other than the named insured or relative injured
through the use or operation of the insured motor vehicle outside of New York
State if such resident is the owner of a motor vehicle for which the coverage
required by the New York Comprehensive Motor Vehicle Insurance Reparations
Act is not in effect; or
(k) any person who is injured while, pursuant to Article 44-B of the Vehicle and Traf-
fic Law, the insured motor vehicle is being used or operated by a transportation
network company driver.
11
INDEX NO. 706270/2023
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Other Definitions
NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/24/2023
When used in reference to this coverage:
(a) the “insured motor vehicle” means a motor vehicle owned by the named insured
and to which the bodily injury liability insurance of this policy applies and for which
a specific premium is charged;
(b) “motorcycle” means a vehicle as defined in section 123 of the New York Vehicle
and Traffic Law and which is required to carry financial security pursuant to article
6, 8 or 48-A of the Vehicle and Traffic Law;
(c) “motor vehicle” means a motor vehicle, as defined in section 311 of the New York
Vehicle and Traffic Law, and also includes fire and police vehicles, but shall not
include any motor vehicle not required to carry financial security pursuant to article
6, 8 or 48-A of the Vehicle and Traffic Law, or a motorcycle as defined above;
(d) “named insured” means the person or organization named on the declarations
page;
(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 re-
sides in the insured’s household, including any such person who regularly resides
in the household, but is temporarily living elsewhere; and
(h) “use or operation” of a motor vehicle or a motorcycle includes the loading or un-
loading of such vehicle.
Conditions
Action Against Company. No action shall lie against the Company unless, as a
condition precedent thereto, there shall have been full compliance with the terms of
this coverage.
Notice. In the event of an accident, written notice setting forth details sufficient to
identify the eligible injured person, along with reasonably obtainable information re-
garding the time, place and circumstances of the accident, shall be given by, or on
behalf of, each eligible injured person, to the Company, or any of the Company’s
authorized agents, as soon as reasonably practicable, but in no event more than 30
days after the date of the accident, unless the eligible injured person submits written
proof providing clear and reasonable justification for the failure to comply with such
time limitation. If an eligible injured person or that person’s legal representative insti-
tutes a proceeding to recover damages for personal injury under section 5104(b) of
the New York Insurance Law, a copy of the summons and complaint or other process
served in connection with such action shall be forwarded as soon as practicable to
the Company or any of the Company’s authorized agents by such eligible injured
person or that person’s legal representative.
Proof of Claim; Medical, Work Loss, and Other Necessary Expenses. In the case
of a claim for health service expenses, the eligible injured person or that person’s
assignee or representative shall submit written proof of claim to the Company, in-
12
INDEX NO. 706270/2023
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cluding full
NYSCEF particulars
DOC. NO. 4of the nature and extent RECEIVED
of the injuriesNYSCEF:
and treatment received
03/24/2023
and contemplated, as soon as reasonably practicable, but in no event later than 45
days after the date services are rendered. The eligible injured person or that person’s
representative shall submit written proof of claim for work loss benefits and for other
necessary expenses to the Company as soon as reasonably practicable but, in no
event, later than 90 days after the work loss is incurred or other necessary services are
rendered. The foregoing time limitations for the submission of proof of claim shall apply
unless the eligible injured person or that person’s representative submits written proof
providing clear and reasonable justification for the failure to comply with such time
limitation. Upon request by the Company, the eligible injured person or that person’s
legal representative shall:
(a) execute a written proof of claim under oath;
(b) as may reasonably be required submit to examinations under oath by any person
named by the Company and subscribe the same;
(c) provide authorization that will enable the Company to obtain medical records; and
(d) provide any other pertinent information that may assist the Company in determin-
ing the amount due and payable.
The eligible injured person shall submit to medical examination by physicians selected
by, or acceptable to, the Company, when, and as often as, the Company may reason-
ably require.
Arbitration. In the event any person making a claim for first-party benefits and the
Company do not agree regarding any matter relating to the claim, such person shall
have the option of submitting such disagreement to arbitration pursuant to procedures
promulgated or approved by the Superintendent of Financial Services.
Reimbursement and Trust Agreement. To the extent that the Company pays first-
party benefits, the Company is entitled to the proceeds of any settlement or judgment
resulting from the exercise of any right of recovery for damages for personal injury
under section 5104(b) of the New York Insurance Law. The Company shall have a
lien upon any such settlement or judgment to the extent that the Company has paid
first-party benefits. An eligible injured person shall:
(a) hold in trust, for the benefit of the Company, all rights of recovery which that person
shall have for personal injury under section 5104(b) of the New York Insurance
Law;
(b) do whatever is proper to secure, and shall do nothing to prejudice, such rights;
and
(c) execute, and deliver to the Company, instruments and papers as may be ap-
propriate to secure the rights and obligations of such person and the Company
established by this provision.
An eligible injured person shall not compromise an action to recover damages brought
under section 5104(b) of the New York Insurance Law, except:
(a) with the written consent of the Company;
(b) with approval of the court; or
(c) where the amount of the set
Preview
FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/24/2023 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/24/2023 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/24/2023 FILED: QUEENS 9611A COUNTY INDEX NO. 706270/2023 NY 0717 CLERK 03/24/2023 08:24 A NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/24/2023 NEW YORK AUTO POLICY Form 9611A NY (07/17) version 2.0 INDEX NO. 706270/2023 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/24/2023 INDEX NO. 706270/2023 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A NYSCEF DOC. NO. 4 CONTENTS RECEIVED NYSCEF: 03/24/2023 INSURING AGREEMENT...................................................................................1 GENERAL DEFINITIONS...................................................................................1 PART I—LIABILITY TO OTHERS Insuring Agreement.......................................................................................4 Additional Definition......................................................................................4 Additional Payments......................................................................................4 Exclusions.....................................................................................................5 Limits of Liability............................................................................................6 Financial Responsibility Laws.......................................................................7 Other Insurance............................................................................................8 Out-of-State Coverage..................................................................................8 PART II(A)—PERSONAL INJURY PROTECTION COVERAGE Mandatory Personal Injury Protection Endorsement (New York)...................8 Optional Basic Economic Loss Coverage Endorsement (New York)........... 15 Additional Personal Injury Protection Endorsement (New York).................. 16 PART II(B)—MEDICAL PAYMENTS COVERAGE Insuring Agreement..................................................................................... 19 Additional Definitions...................................................................................20 Exclusions...................................................................................................20 Limits of Liability..........................................................................................21 Unreasonable or Unnecessary Medical Expenses.....................................22 Other Insurance..........................................................................................22 PART III—UNINSURED MOTORISTS COVERAGE Uninsured Motorists Endorsement..............................................................22 Supplementary Uninsured/Underinsured Motorists Endorsement..............29 PART IV—DAMAGE TO A VEHICLE Insuring Agreement—Collision Coverage...................................................35 Insuring Agreement—Comprehensive Coverage........................................35 Insuring Agreement—Additional Custom Parts or Equipment Coverage.........36 Insuring Agreement—Rental Reimbursement Coverage.............................36 Insuring Agreement—Pet Injury Coverage..................................................37 Additional Definitions...................................................................................37 Exclusions...................................................................................................38 Limits of Liability..........................................................................................39 Waiver of Collision Deductible.....................................................................41 Recovery of Stolen or Abandoned Vehicles................................................41 Payment of Loss.........................................................................................41 Mandatory Inspection..................................................................................41 i INDEX NO. 706270/2023 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A AutoDOC. NYSCEF Repairs. NO................................................................................................41 4 RECEIVED NYSCEF: 03/24/2023 No Benefit to Bailee....................................................................................42 Loss Payable Clause...................................................................................42 Other Sources of Recovery.........................................................................42 Appraisal.....................................................................................................42 PART V—ROADSIDE ASSISTANCE COVERAGE Insuring Agreement.....................................................................................43 Unauthorized Service Provider...................................................................43 Additional Definitions...................................................................................43 Exclusions...................................................................................................44 Other Insurance..........................................................................................44 PART VI—DUTIES IN CASE OF AN ACCIDENT OR LOSS.............................44 PART VII—GENERAL PROVISIONS Policy Period and Territory...........................................................................46 Changes......................................................................................................46 Duty to Report Changes.............................................................................47 Settlement of Claims...................................................................................47 Terms of Policy Conformed to Statutes.......................................................47 Transfer of Interest......................................................................................47 Fraud or Misrepresentation.........................................................................47 Payment of Premium and Fees...................................................................48 Cancellation................................................................................................48 Cancellation Refund....................................................................................49 Nonrenewal.................................................................................................50 Payment or Performance............................................................................50 Legal Action Against Us..............................................................................50 Our Rights to Recover Payment..................................................................50 Joint and Individual Interests.......................................................................51 Bankruptcy..................................................................................................51 RENTAL VEHICLE COVERAGE ENDORSEMENT..........................................51 ii INDEX NO. 706270/2023 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A NYSCEF DOC. NO. 4 NEW YORK AUTORECEIVED POLICY NYSCEF: 03/24/2023 INSURING AGREEMENT In return for your payment of the premium, we agree to insure you subject to all the terms, conditions and limitations of this policy. We will insure you for the coverages and the limits of liability shown on this policy’s declarations page. Your policy consists of the policy contract, your insurance application, the declarations page, and all en- dorsements to this policy. GENERAL DEFINITIONS The following definitions apply throughout the policy. Defined terms are printed in bold- face type and have the same meaning whether in the singular, plural, or any other form. 1. “Additional auto” means an auto you become the owner of during the policy pe- riod that does not permanently replace an auto shown on the declarations page if: a. we insure all other autos you own; b. the additional auto is not covered by any other insurance policy; c. you notify us within 30 days of becoming the owner of the additional auto; and d. you pay any additional premium due. An additional auto will have the broadest coverage we provide for any auto shown on the declarations page. If you ask us to insure an additional auto more than 30 days after you become the owner, any coverage we provide will begin at the time you request coverage. 2. “Auto” means a land motor vehicle: a. of the private passenger, pickup body, or cargo van type; b. designed for operation principally upon public roads; c. with at least four wheels; and d. with a gross vehicle weight rating of 12,000 pounds or less, according to the manufacturer’s specifications. However, “auto” does not include step-vans, parcel delivery vans, or cargo cutaway vans or other vans with cabs separate from the cargo area. 3. “Auto business” means the business of selling, leasing, repairing, parking, storing, servicing, delivering or testing vehicles. 4. “Bodily injury” means bodily harm, sickness, or disease, including death that re- sults from bodily harm, sickness, or disease. 5. “Covered auto” means: a. any auto or trailer shown on the declarations page for the coverages ap- plicable to that auto or trailer, provided such auto or trailer is predominantly used for non-business purposes. b. any additional auto; c. any replacement auto; or d. a trailer owned by you. 6. “Declarations page” means the document showing your coverages, limits of li- ability, covered autos, premium, and other policy-related information. The declara- tions page may also be referred to as the Auto Insurance Coverage Summary. 1 INDEX NO. 706270/2023 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A 7. “Digital NYSCEF DOC.network” NO. 4means any system or service offered or RECEIVED a transpor- utilized by03/24/2023 NYSCEF: tation network company that enables TNC prearranged trips with transporta- tion network company drivers. 8. “Occupying” means in, on, entering or exiting. 9. “Property damage” means physical damage to, destruction of, or loss of use of, tangible property. 10. “Rated resident” means a person residing in the same household as you at the time of the loss who is not a relative, but only if that person is both: a. listed in the “Drivers and household residents” section on the declarations page; and b. not designated as a “List Only” driver. 11. “Relative” means a person residing in the same household as you, and related to you by blood, marriage or adoption, and includes a ward, stepchild, or foster child. Your unmarried dependent children temporarily away from home will qualify as a relative if they intend to continue to reside in your household. 12. “Replacement auto” means an auto that permanently replaces an auto shown on the declarations page. A replacement auto will have the same coverage as the auto it replaces if the replacement auto is not covered by any other insurance policy. However, if the auto being replaced had coverage under Part IV—Damage To A Vehicle, such coverage will apply to the replacement auto only during the first 30 days after you become the owner unless you notify us within that 30-day period that you want us to extend coverage beyond the initial 30 days. If the auto being replaced did not have coverage under Part IV—Damage To A Vehicle, such cover- age may be added, but the replacement auto will have no coverage under Part IV until you notify us of the replacement auto and ask us to add the coverage. 13. “Trailer” means a non-motorized, non-commercial trailer, including a farm wagon or farm implement, designed to be towed on public roads by an auto and not be- ing used: a. for commercial purposes; b. as an office, store, or for display purposes; or c. as a passenger conveyance. Trailer does not include a mobile home or manufactured home. 14. “Transportation network company” or “TNC” means a person, corporation, partnership, sole proprietorship, or other entity that is licensed pursuant to Article 44-B of the New York Vehicle and Traffic Law and is operating in New York state exclusively using a digital network to connect transportation network compa- ny passengers to transportation network company drivers who provide TNC prearranged trips. 15. “Transportation network company driver” means an individual who: a. receives connections to potential passengers and related services from a transportation network company in exchange for payment of a fee to the transportation network company; and b. uses a TNC vehicle to offer or provide a TNC prearranged trip to trans- portation network company passengers upon connection through a digital network controlled by a transportation network company in exchange for compensation or payment of a fee. 2 INDEX NO. 706270/2023 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A 16. “Transportation NYSCEF DOC. NO. 4 network company prearranged RECEIVED trip”NYSCEF: means the03/24/2023 provision of transportation by a transportation network company driver to a passenger pro- vided through the use of a TNC’s digital network: a. beginning when a transportation network company driver accepts a pas- senger’s request for a trip through a digital network controlled by a trans- portation network company; b. continuing while the transportation network company driver transports the requesting passenger in a TNC vehicle; and c. ending when the last requesting passenger departs from the TNC vehicle. The term “Transportation network company prearranged trip” does not in- clude transportation provided through any of the following: a. shared expense carpool or vanpool arrangements, including those as defined in section one hundred fifty-eight-b of this chapter; and b. use of a taxicab, livery, luxury limousine, or other for-hire vehicle, as defined in this chapter, section 19-502 of the administrative code of the city of New York, or as otherwise defined in local law. 17. “Transportation network company vehicle” or “TNC vehicle” means a vehicle that is: a. used by a transportation network company driver to provide a TNC prear- ranged trip originating within the state of New York; and b. owned, leased or otherwise authorized for use by the transportation net- work company driver; c. such term shall not include: i. a taxicab, as defined in section one hundred forty-eight-a of this chapter and section 19-502 of the administrative code of the city of New York, or as otherwise defined in local law; ii. a livery vehicle, as defined in section one hundred twenty-one-e of this chapter, or as otherwise defined in local law; iii. a black car, limousine, or luxury limousine, as defined in section 19-502 of the administrative code of the city of New York, or as otherwise defined in local law; iv. a for-hire vehicle, as defined in section 19-502 of the administrative code of the city of New York, or as otherwise defined in local law; v. a bus, as defined in section one hundred four of this chapter; vi. any motor vehicle weighing more than six thousand five hundred pounds unloaded; vii. any motor vehicle having a seating capacity of more than seven passen- gers; and viii. any motor vehicle subject to section three hundred seventy of this chapter. 18. “We,” “us” and “our” mean the underwriting company providing the insurance, as shown on the declarations page. 19. “You” and “your” mean: a. a person shown as a named insured on the declarations page; and b. the spouse of a named insured if residing in the same household at the time of the loss. 3 INDEX NO. 706270/2023 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A NYSCEF DOC. NO. 4 PART I—LIABILITY TO OTHERS NYSCEF: 03/24/2023 RECEIVED INSURING AGREEMENT If you pay the premium for this coverage, we will pay damages, other than punitive or exemplary damages, for bodily injury and property damage for which an insured person becomes legally responsible because of an accident. Damages include prejudgment interest awarded against an insured person. We will settle or defend, as we consider appropriate, any claim for damages covered by this Part I. This applies even if the claim or suit is groundless or false. ADDITIONAL DEFINITION When used in this Part I: “Insured person” means: a. you, a relative, or a rated resident with respect to an accident arising out of the ownership, maintenance or use of a trailer shown on the declarations page or a covered auto; b. you or a relative with respect to an accident arising out of the ownership, mainte- nance, or use of an auto or trailer with the permission of the owner of the vehicle or the person in lawful possession of the vehicle; c. any person with respect to an accident arising out of that person’s use of a cov- ered auto with the permission of you, a relative, or a rated resident; d. any person or organization with respect only to vicarious liability for the acts or omissions of a person described in a., b., or c. above; and e. any “Additional Interest” shown on the declarations page with respect only to its liability for the acts or omissions of a person described in a., b., or c. above. ADDITIONAL PAYMENTS In addition to our limit of liability, we will pay for an insured person: 1. all expenses we incur, and all costs taxed against the insured person, in the settlement of any claim or defense of any lawsuit; 2. interest accruing after entry of judgment, until we have paid, offered to pay, or deposited in court, that portion of the judgment which does not exceed our limit of liability. This does not apply if we have not been given notice of suit or the op- portunity to defend an insured person; 3. the premium on any appeal bond or attachment bond required in any lawsuit we defend. We have no duty to purchase a bond in an amount exceeding our limit of liability, and we have no duty to apply for or furnish these bonds; 4. up to $250 for a bail bond required because of an accident resulting in bodily injury or property damage covered under this Part I. We have no duty to apply for or furnish this bond; 5. expenses incurred by the insured person for first aid to others at the time of the accident; and 4 INDEX NO. 706270/2023 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A 6. reasonable NYSCEF expenses, DOC. NO. 4 including loss of earnings up to $200 RECEIVED per day, NYSCEF: incurred at 03/24/2023 our request. EXCLUSIONS—READ THE FOLLOWING EXCLUSIONS CAREFULLY. IF AN EXCLUSION APPLIES, COVERAGE WILL NOT BE AFFORDED UNDER THIS PART I. Coverage under this Part I, including our duty to defend, will not apply to any insured person for: 1. bodily injury or property damage arising out of the ownership, maintenance or use of any vehicle while being used as a public or livery conveyance. This exclu- sion does not apply to shared-expense car pools; 2. any liability assumed under any contract or agreement by you, a relative, or a rated resident; 3. bodily injury to an employee of that insured person arising out of or within the course of employment. This exclusion does not apply to domestic employees if benefits are neither paid nor required to be provided under workers’ compensa- tion, disability benefits, or similar laws; 4. bodily injury or property damage arising out of an accident involving an auto or trailer while being maintained or used by a person while employed or engaged in any auto business. This exclusion does not apply to you, a relative, a rated resident, or an agent or employee of you, a relative, or a rated resident, when using a covered auto; 5. any obligation for which the United States Government is liable under the Federal Tort Claims Act; 6. bodily injury or property damage caused by an intentional act of that insured person, or at the direction of that insured person; 7. property damage to any property owned by, rented to, being transported by, used by, or in the charge of that insured person. This exclusion does not apply to a rented residence or a rented garage; 8. property damage sustained by the spouse of an insured person. However, this exclusion does not apply to deny coverage to a spouse if named as a third-party defendant in a lawsuit brought by his or her spouse against another party; 9. bodily injury or property damage arising out of the ownership, maintenance or use of any vehicle owned by you or furnished or available for your regular use, other than a covered auto for which this coverage has been purchased; 10. bodily injury or property damage arising out of the ownership, maintenance or use of any vehicle owned by a relative or a rated resident or furnished or avail- able for the regular use of a relative or a rated resident, other than a covered auto for which this coverage has been purchased. This exclusion does not apply to your maintenance or use of such vehicle; or 11. bodily injury or property damage sustained while the vehicle is used by a trans- portation network company driver who is logged onto the transportation net- work company’s digital network but is not engaged in a transportation net- work company prearranged trip or while the driver provides a transportation network company prearranged trip. 5 INDEX NO. 706270/2023 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A LIMITS OF NYSCEF LIABILITY DOC. NO. 4 RECEIVED NYSCEF: 03/24/2023 If your declarations page shows a split limit: 1. the amount shown for “each person” is the most we will pay for all damages due to bodily injury to one person resulting from any one accident; 2. subject to the “each person” limit, the amount shown for “each accident” is the most we will pay for all damages due to bodily injury sustained by two or more persons in any one accident; and 3. the amount shown for “property damage” is the most we will pay for the total of all property damage resulting from any one accident. However, if your policy has bodily injury split limits of: 1. $25,000 “each person” and $50,000 “each accident” for coverage under this Part I, as shown on the declarations page, then the split limits set forth in the paragraph above shall not apply to bodily injury that results in death, and the following ad- ditional coverage will apply in the event of bodily injury that results in death, to the extent required by New York law: a. our limit of liability for damages due to bodily injury that results in the death of one person in any one accident is $50,000; or b. if two or more persons sustain bodily injury that results in death, our limit of liability for bodily injury that results in the death of two or more persons in any one accident is $100,000; or 2. $50,000 “each person” and $100,000 “each accident” for coverage under this Part I, as shown on the declarations page, then the split limits set forth in the para- graphs above for bodily injury shall not apply, and our limit of liability, to the extent required by New York law, will be as follows: a. for any accident that causes bodily injury that results in the death of one person, the most we will pay for all damages due to bodily injury that results in death is $50,000; b. if only one person sustains bodily injury that does not result in death, the limit of liability for damages due to bodily injury to the one person is $50,000; c. subject to the per person limit, if two or more persons sustain bodily injury that does not result in death, the limit of liability for all damages due to bodily injury that does not result in death is $100,000; or d. for any accident that causes bodily injury that results in the death of two or more persons, the most we will pay for all damages due to bodily injury that results in death in any one accident is $100,000, and the limit of liability for all other bodily injury that does not result in death is: (i) $50,000 if only one person sustains bodily injury in any one accident; or (ii) subject to the per person limit, $100,000 for two or more persons sustain- ing bodily injury in any one accident. The above Limits of Liability with respect to bodily injury that results in death are subject to the following reductions: 1. in the event of the death of one person in any accident, our $50,000 limit of liability will be reduced by any amounts paid to or on behalf of that person under this Part I; and 6 INDEX NO. 706270/2023 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A 2. in the NYSCEF eventNO. DOC. of the4 death of two or more persons RECEIVED accident, our in anyNYSCEF: $100,000 03/24/2023 limit of liability will be reduced by any amounts paid to or on behalf of those per- sons under this Part I. The limits of liability described above for “each person” and for “one person” apply to the total of all claims made for bodily injury to a person and all claims of others derived from such bodily injury, including, but not limited to, loss of society, loss of compan- ionship, loss of services, loss of consortium, and wrongful death. The limit of liability for bodily injury that results in the death of two or more persons in any one accident includes the total of all claims made for such bodily injury and all claims of others derived from such bodily injury, including, but not limited to, loss of so- ciety, loss of companionship, loss of services, loss of consortium, and wrongful death. If the declarations page shows that “combined single limit” or “CSL” applies, the amount shown is the most we will pay for the total of all damages resulting from any one accident. However, without changing this limit of liability, we will comply with any law that requires us to provide any separate limits. The limit of liability shown on the declarations page is the most we will pay regardless of the number of: 1. claims made; 2. covered autos; 3. insured persons; 4. lawsuits brought; 5. vehicles involved in the accident; or 6. premiums paid. No one is entitled to duplicate payments for the same elements of damages. Any payment to a person under this Part I will be reduced by any payment to that per- son under Part III—Uninsured Motorists Coverage. We will not pay under this Part I any expenses paid or payable under Part II(B)—Medical Payments Coverage. An auto and attached trailer are considered one auto. Therefore, the limits of liability will not be increased for an accident involving an auto that has an attached trailer. FINANCIAL RESPONSIBILITY LAWS When we issue this policy as proof of financial responsibility, this policy will comply with the law to the extent required. 7 INDEX NO. 706270/2023 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A OTHER INSURANCE NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/24/2023 If there is any other valid and collectible liability insurance or bond that applies to the accident, we will pay only our share of the damages. Our share is the proportion that our limit of liability bears to the total of all applicable limits. However, any insurance we provide for a vehicle or trailer, other than a covered auto, will be excess over any other valid and collectible insurance, self-insurance, or bond. OUT-OF-STATE COVERAGE If an accident to which this Part I applies occurs in any state, territory or possession of the United States of America or any province or territory of Canada, other than the one in which a covered auto is principally garaged, and the state, province, territory or possession has: 1. a financial responsibility or similar law requiring limits of liability for bodily injury or property damage higher than the limits shown on the declarations page, this policy will provide the higher limits; or 2. a compulsory insurance or similar law requiring a non-resident to maintain insur- ance whenever the non-resident uses an auto in that state, province, territory or possession, this policy will provide the greater of: a. the required minimum amounts and types of coverage; or b. the limits of liability under this policy. PART II(A)—PERSONAL INJURY PROTECTION COVERAGE MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT (New York) The Company agrees with the named insured, as follows: Section I Mandatory Personal Injury Protection The company will pay first-party benefits to reimburse for basic economic loss sus- tained by an eligible injured person on account of personal injuries caused by an ac- cident arising out of the use or operation of a motor vehicle or a motorcycle during the policy period and within the United States of America, its territories or possessions, or Canada. First-party Benefits First-party benefits, other than death benefits, are payments equal to basic economic loss, reduced by the following: (a) 20 percent of the eligible injured person’s loss of earnings from work to the extent that an eligible injured person’s basic economic loss consists of such loss of earn- ings; 8 INDEX NO. 706270/2023 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A (b) amounts NYSCEF DOC.recovered NO. 4 or recoverable on account of personal RECEIVED injury to NYSCEF: an eligible 03/24/2023 injured person under State or Federal laws providing social security disability or workers’ compensation benefits, or disability benefits under article 9 of the New York Workers’ Compensation Law; (c) the amount of any applicable deductible, provided that such deductible shall apply to each accident, but only to the total of first-party benefits otherwise payable to the named insured and any relative as a result of that accident. 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 $50,000, except that any death benefit hereunder shall be in addition thereto. Medical Expense Medical expense shall consist of necessary expenses for: (a) medical, hospital (including services rendered in compliance with article 41 of the Public Health Law, whether or not such services are rendered directly by a hospi- tal), 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 reli- gious method of healing recognized by the laws of New York; and (d) any other professional health services. These medical expenses will not be subject to a time limitation, provided that, within one year after the date of the accident, it is ascertainable that further medical ex- penses may be sustained as a result of the injury. Payments hereunder for necessary medical expenses shall be subject to the limitations and requirements of section 5108 and Regulation 83 of the New York Insurance Law. Work Loss Work loss shall consist of the sum of the following losses and expenses, up to a maxi- mum payment of $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 such person not been injured, except that an employee who is entitled to re- ceive monetary payments, pursuant to statute or contract with the employer, or who receives voluntary monetary benefits paid for by the employer, by reason of such employee’s inability to work because of personal injury arising out of the use or operation of a motor vehicle or a motorcycle, shall not be entitled to receive first-party benefits for loss of earnings from work to the extent that such monetary 9 INDEX NO. 706270/2023 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A NYSCEFpayments DOC. orNO. benefits 4 from the employer doRECEIVED not result inNYSCEF: the employee suffering 03/24/2023 a reduction in income or a reduction in such employee’s level of future benefits arising from a subsequent illness or injury; and (b) reasonable and necessary expenses sustained by the eligible injured person in obtaining services in lieu of those which such person would have performed for income. Other Expenses Other expenses shall consist of all reasonable and necessary expenses, other than medical expense and work loss, up to $25 per day for a period of one year from the date of the accident causing injury. Death Benefit Upon the death of any eligible injured person, caused by an accident to which this cover- age applies, the company will pay to the estate of such person a death benefit of $2,000. Eligible Injured Person Subject 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 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 motorcycle, while not occupying a motorcycle; (c) any other person 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. Exclusions This coverage does not apply to personal injury sustained by: (a) the named insured while occupying, or while a pedestrian through being struck by, any motor vehicle owned by the named insured with respect to which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is not in effect; (b) any relative while occupying, or while a pedestrian through being struck by, any motor vehicle owned by the relative with respect to which the coverage required by the New York Comprehensive 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 to which the coverage required by the New York Comprehensive 10 INDEX NO. 706270/2023 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A NYSCEFMotor Vehicle DOC. NO.Insurance 4 Reparations Act is RECEIVED in effect; however, this exclusion NYSCEF: does 03/24/2023 not apply 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; (d) any person while occupying a motorcycle; (e) any person who intentionally causes his or her own personal injury; (f) any person as a result of operating a motor vehicle while in an intoxicated condi- tion or while his or her ability to operate the vehicle is impaired by the use of a drug (within the meaning of section 1192 of the New York Vehicle and Traffic Law) except that coverage shall apply to necessary emergency health services rendered in a general hospital, as defined in section 2801(10) of the New York Public Health Law, including ambulance services attendant thereto and related medical screening. However, where the person has been convicted of violating section 1192 of the New York Vehicle and Traffic Law while operating a motor vehicle in an intoxicated condition or while his or her ability to operate such vehicle is impaired by the use of a drug, and the conviction is a final determination, the Company has a cause of action against such person for the amount of first party benefits that are paid or payable; or (g) any person while: (1) committing an act which would constitute a felony, or seeking to avoid lawful apprehension or arrest by a law enforcement officer; (2) operating a motor vehicle in a race or speed test; (3) operating or occupying a motor vehicle known to that person to be stolen; or (4) repairing, servicing or otherwise maintaining a motor vehicle if the conduct is within the course of a business of repairing, servicing or otherwise maintain- ing a motor vehicle and the injury occurs on the business premises; (h) the named insured or relative while not occupying a motor vehicle or a motor- cycle when struck by a motorcycle in New York State with respect to which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is in effect; (i) any New York State resident other than the named insured or relative injured through the use or operation of the insured motor vehicle outside of New York State if such resident is the owner or a relative of the owner of a motor vehicle insured under another policy providing the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act; (j) any New York State resident other than the named insured or relative injured through the use or operation of the insured motor vehicle outside of New York State if such resident is the owner of a motor vehicle for which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is not in effect; or (k) any person who is injured while, pursuant to Article 44-B of the Vehicle and Traf- fic Law, the insured motor vehicle is being used or operated by a transportation network company driver. 11 INDEX NO. 706270/2023 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A Other Definitions NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/24/2023 When used in reference to this coverage: (a) the “insured motor vehicle” means a motor vehicle owned by the named insured and to which the bodily injury liability insurance of this policy applies and for which a specific premium is charged; (b) “motorcycle” means a vehicle as defined in section 123 of the New York Vehicle and Traffic Law and which is required to carry financial security pursuant to article 6, 8 or 48-A of the Vehicle and Traffic Law; (c) “motor vehicle” means a motor vehicle, as defined in section 311 of the New York Vehicle and Traffic Law, and also includes fire and police vehicles, but shall not include any motor vehicle not required to carry financial security pursuant to article 6, 8 or 48-A of the Vehicle and Traffic Law, or a motorcycle as defined above; (d) “named insured” means the person or organization named on the declarations page; (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 re- sides in the insured’s household, including any such person who regularly resides in the household, but is temporarily living elsewhere; and (h) “use or operation” of a motor vehicle or a motorcycle includes the loading or un- loading of such vehicle. Conditions Action Against Company. No action shall lie against the Company unless, as a condition precedent thereto, there shall have been full compliance with the terms of this coverage. Notice. In the event of an accident, written notice setting forth details sufficient to identify the eligible injured person, along with reasonably obtainable information re- garding the time, place and circumstances of the accident, shall be given by, or on behalf of, each eligible injured person, to the Company, or any of the Company’s authorized agents, as soon as reasonably practicable, but in no event more than 30 days after the date of the accident, unless the eligible injured person submits written proof providing clear and reasonable justification for the failure to comply with such time limitation. If an eligible injured person or that person’s legal representative insti- tutes a proceeding to recover damages for personal injury under section 5104(b) of the New York Insurance Law, a copy of the summons and complaint or other process served in connection with such action shall be forwarded as soon as practicable to the Company or any of the Company’s authorized agents by such eligible injured person or that person’s legal representative. Proof of Claim; Medical, Work Loss, and Other Necessary Expenses. In the case of a claim for health service expenses, the eligible injured person or that person’s assignee or representative shall submit written proof of claim to the Company, in- 12 INDEX NO. 706270/2023 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 A cluding full NYSCEF particulars DOC. NO. 4of the nature and extent RECEIVED of the injuriesNYSCEF: and treatment received 03/24/2023 and contemplated, as soon as reasonably practicable, but in no event later than 45 days after the date services are rendered. The eligible injured person or that person’s representative shall submit written proof of claim for work loss benefits and for other necessary expenses to the Company as soon as reasonably practicable but, in no event, later than 90 days after the work loss is incurred or other necessary services are rendered. The foregoing time limitations for the submission of proof of claim shall apply unless the eligible injured person or that person’s representative submits written proof providing clear and reasonable justification for the failure to comply with such time limitation. Upon request by the Company, the eligible injured person or that person’s legal representative shall: (a) execute a written proof of claim under oath; (b) as may reasonably be required submit to examinations under oath by any person named by the Company and subscribe the same; (c) provide authorization that will enable the Company to obtain medical records; and (d) provide any other pertinent information that may assist the Company in determin- ing the amount due and payable. The eligible injured person shall submit to medical examination by physicians selected by, or acceptable to, the Company, when, and as often as, the Company may reason- ably require. Arbitration. In the event any person making a claim for first-party benefits and the Company do not agree regarding any matter relating to the claim, such person shall have the option of submitting such disagreement to arbitration pursuant to procedures promulgated or approved by the Superintendent of Financial Services. Reimbursement and Trust Agreement. To the extent that the Company pays first- party benefits, the Company is entitled to the proceeds of any settlement or judgment resulting from the exercise of any right of recovery for damages for personal injury under section 5104(b) of the New York Insurance Law. The Company shall have a lien upon any such settlement or judgment to the extent that the Company has paid first-party benefits. An eligible injured person shall: (a) hold in trust, for the benefit of the Company, all rights of recovery which that person shall have for personal injury under section 5104(b) of the New York Insurance Law; (b) do whatever is proper to secure, and shall do nothing to prejudice, such rights; and (c) execute, and deliver to the Company, instruments and papers as may be ap- propriate to secure the rights and obligations of such person and the Company established by this provision. An eligible injured person shall not compromise an action to recover damages brought under section 5104(b) of the New York Insurance Law, except: (a) with the written consent of the Company; (b) with approval of the court; or (c) where the amount of the set