Provisions and procedures used by insurers to avoid duplicate payment for losses insured under more than one Insurance policy. For example, some people have a duplication of benefits for their medical costs arising from an automobile accident, in their automobile and health insurance policies. A coordination of benefits or anti-duplication clause in one or the other policy will prevent double payment for the expenses by making one of the insurers the primary payer, and assuring that no more than 100 percent of the costs are covered. There are standard rules for determining which of two or more plans, each having COB provision, pays its benefits in full and which pays a sufficiently reduced benefit to prevent the claimant from making a profit.
An insurance claims review process used when a beneficiary is insured by two or more carriers. The process determines the liability of each carrier in order to eliminate duplication of payments. For example, benefits to which an individual is entitled under workers’ compensation are not permitted to be duplicated by ordinary health insurance, even though the injury or illness would be covered were the problem not work-related.
Insurance policy provisions that govern how benefits for multiply insured parties are to be paid. The total benefits paid are linked so that the amount paid on behalf of the insured does not exceed the fee for the service provided.