The laws require the adjusters to adjust claims in favor of coverage but the companies routinely violate this law. Most health insurance is employer provided which means under ERISA, one vital incentive to adjust claims fairly, bad faith insurance lawsuits, are barred. Thus, there is no real incentive to adjust claims consistent with law.

If an insurer is double the national average, that's just wrong.

Claim denial is intended to deny where coverage is clearly excluded, not where it is expensive.