In dual coverage scenarios, pro-rata payments occur if no notification of other coverage before claim is given.

• A. True
• B. False
• C. Only if the primary insurer denies the claim
• D. Only if the insured requests it

Answer: (A)

Coordination of benefits governs how two policies share a claim when more than one coverage exists. If the insured doesn’t notify the other coverage before a claim is filed, the plans may not be able to determine which should pay first, so expenses are shared on a pro-rata basis. That means each policy pays a portion of the allowed charges proportional to its coverage, helping to avoid duplicate payments and ensure the claim is split fairly between the two carriers. Because no notification was given to coordinate benefits, pro-rata payments are the expected outcome.