Game crashes as soon as I hit play, the screen goes black as though it's about to load. Then the launcher in the background crashes as well.

Here is the windows error report:

Problem signature:
Problem Event Name: APPCRASH
Application Name: FalloutNV.exe
Application Version: 1.0.0.240
Application Timestamp: 4c9808f2
Fault Module Name: FalloutNV.exe
Fault Module Version: 1.0.0.240
Fault Module Timestamp: 4c9808f2
Exception Code: c0000005
Exception Offset: 006002a5
OS Version: 6.1.7600.2.0.0.768.3
Locale ID: 1033
Additional Information 1: 0a9e
Additional Information 2: 0a9e372d3b4ad19135b953a78882e789
Additional Information 3: 0a9e
Additional Information 4: 0a9e372d3b4ad19135b953a78882e789

Win 7 X64
Steam
Direct X 11
ATI 4870 1GB Up to date drivers
Core 2 Duo 3GHZ
8gb ddr2 ram

I've tried all settings from low to ultra, disabling steam community in-game, running as admin, compatibily...