No-Fault Insurance and Workman's Comp Flashcards
Carrying insurance in NY
Compulsory
Coverage - No Fault Ins
$50,000 “first-party” benefits (no-fault payable to the insured) plus minimum liability coverage if insured is sued by a third party in tort action. Only covers actual use/operation of motor vehicle.
Covered Persons - No Fault Ins
Persons injured by insured owner’s vehicle, including owner, operator, occupants, and pedestrians. Does NOT include: persons injured by their own intentional acts; while operating a vehicle intoxicated; while committed a felony or attempting to avoid arrest; while racing a motor vehicle or attempting speed test; while driving vehicle you know is stolen; while operating your own vehicle or being struck by your own vehicle for which no-fault coverage is not in effect; or while repairing/servicing/maintaining motor vehicle on business premises.
Geography - NFI
Anywhere inNY or other state
First Party Benefits
NOT pain and suffering. Includes basic economic loss, including medical expenses, lost earnings (limited to $2,000 per month for not more than 3 years); non-incoming producing expenses up to $25 per day for not more than 1 year, but can recover a maximum of 80% of basic economic loss attributable to lost earnings. No deduction in payments under the policy for insurance from other sources.
Tort Actions Still Permitted
A covered person can sue a non-covered person for all damages but the insurer has a lien against recovery for all first-party benefits paid to a covered person. A non-covered person can only sue a covered person if the injuries were “serious” (death; dismemberment; significant disfigurement; a fracture; loss of a fetus; permanent loss of use of a body organ, member, function or system; permanent consequential limitation of use of a body organ or member; significant limitation of use of a body function or system, or a medically determined injury or impairment of a non permanent nature which prevents the injured person from performing substantially all of the material acts which constitute such person’s usual and customary daily activities for not less that ninety days during the one hundred eighty days immediately following the occurrence of the injury or impairment.)
Settlement
A covered person may not settle with a non-covered person unless (1) written consent from insurer; (2) settlement approved by court; or (3) settlement >$50,000
Workers Comp- Covered
Most employees in business/trade/profession
Workers Comp - persons excluded
White collar workers for religious/charitable/educational institutions; babysitters/domestic household help; and spiritual leaders/members of religious order.
Casualties covered
accidental injuries out of course of employment and disease/infection naturally resulting therefrom
occupational disease resulting in disability or death. Employees injured while committing illegal act in course of employment ARE covered.
Casualties not covered
injuries that were intentional to himself or another; voluntary participation in off-duty athletic activity; intoxication of injured employee on duty. Employees injured while committing illegal act in course of employment ARE covered.
Exclusive remedy
Employee’s claim under WC is exclusive remedy against employer, co-employees. Can still maintain action against third parties, and they may seek contribution for GRAVE injury only. Wrongful death action against employer barred.
Extent of benefits
medical services, medication, apparatus; compensation in event of disability from work, generally 2/3 of average wkly wages; death benefits on statutory schedule and funeral expenses; double compensation and death benefits for injured minors illegal employed.
Waiver of right to compensation
VOID against public policy
