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Accident claims, checked against the plan before they pay.

Accident plans pay scheduled amounts across many benefit types, within limits set by the plan. The same accident can arrive more than once, described differently each time. Trestl checks each claim line against the plan before payment and holds possible repeats for review.

Talk about your Accident book

What the member and the plan get.

Claims are checked against the member’s plan before payment, and every finding shows its reason.

  1. Paid as the plan schedules

    Each payment is compared with what the plan schedule produces. Overpayments and underpayments are both flagged.

  2. Paid within the plan's limits

    The benefit limits written in your certificate are applied before payment.

  3. Paid once

    A claim that repeats a payment already made is held for review.

  4. One accident, paid onceAI-assisted

    Accident reports are reviewed with AI assistance; a possible repeat is held for review, with the reports side by side.

From the member’s side: a fracture paid at the wrong amount.

Underpayment · Sam, a member with a group Accident plan. The people and amounts are made up.

  1. Day 1

    Sam breaks a wrist and files an Accident claim with the treating physician’s note.

  2. Without a check

    The claim is paid $250 instead of the $500 the plan schedules.

  3. Months later

    Sam notices, calls, and waits for an adjustment, or never notices at all.

  4. With Trestl

    Before payment, the $250 difference from the plan’s schedule is flagged, with the reason. Sam is paid $500 the first time.

It fits the way your team already works.

  1. You send the claims

    The way your system already shares them.

  2. We check them against the plan

    Before your payment run.

  3. Your examiners decide what we flag

    With the reason in front of them. Claims that match pay on schedule.

Ready for your security review: a platform hosted in the US, each client’s data kept apart, encryption, and a BAA. Security and trust

What reviewers ask about Accident

Does Trestl replace our claims adjudication system?
No. Trestl reviews claims before payment and presents findings to your analysts or returns them to your system. Your team, or your authorized TPA, keeps claim adjudication, appeal, and payment authority.
Is an AI-assisted flag a denial?
No. AI-assisted checks surface items for an analyst to review. An alert is not a final denial or a confirmed saving; people make the decision and the decision is recorded.
How is AI used on Accident claims?
Accident reports are analyzed with Google Cloud Vertex AI to help an analyst spot an incident that may already have been claimed. Possible matches go to an analyst with the reports side by side; nothing is denied automatically.
Can Trestl review Accident claims that were already paid?
Yes, as an optional historical diagnostic under an agreed scope. The report states which checks ran, any data gaps, and what was found, which can include no confirmed errors.

The other lines we cover.

Start with a conversation about your lines.

A first call about your lines and how claims move today. No claim files or health information needed for the call.

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