Accident · ACC
Accident claims, checked per accident and per plan year
Accident plans pay scheduled amounts across many benefit types, with limits per accident and per plan year. The same accident can arrive more than once, described differently each time. Trestl recalculates amounts, enforces limits, and looks for duplicate incidents before payment.
Where errors hide
What goes wrong in Accident claims
Most payment errors in fixed-benefit lines are not fraud. They are small mismatches between the claim and the plan, repeated across a book.
- The same incident submitted as two accidents
- Benefits paid beyond the per-accident limit
- Scheduled amounts keyed to the wrong benefit
- Plan-year counts that no longer match history
What Trestl checks
Accident checks, before payment
Each check is configured to your plans. Applicability depends on your policy wording and the reference data available, which we confirm during discovery.
Benefit amounts
Scheduled amounts are recalculated for each accident benefit type. Overpayments and underpayments are both flagged.
Per-accident and plan-year limits
Count-based limits are enforced per accident and per plan year, against the member’s claim history.
Duplicate incidents
AI-assistedAccident report narratives are compared semantically to find one incident submitted as separate accidents. Matches go to an analyst for review.
Duplicate claims
Matches exact duplicates in claim history over a configurable lookback window.
Findings are presented for review with the rule and evidence behind them. Your team, or your authorized TPA, keeps claim adjudication, appeal, and payment authority.
Frequently asked questions
- 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 does duplicate accident detection work?
- Accident report text is analyzed with Google Cloud Vertex AI and compared with the member’s prior reports for the benefit types that can pay more than once per accident. Likely matches are flagged for 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.
Start with your Accident book
Start with a conversation about your book, the claim decisions that need attention, and who owns them. We will show the platform on synthetic data and agree whether a scoped review makes sense.