Taking the scenarios I’m laying out, coming up with something different, and saying “I think this is what you are talking about” does not change the reality.
Bottom line, insurance companies regularly attempt to pay less than they are obligated to pay under contract, to the point that there is a whole, very lucrative profession on the sole purpose of fighting for the insured when they are not paid what they are due. There are literally thousands upon thousands of people making a very good living by fighting for and collecting what the insurance companies owe, after they’ve denied full or partial payment of claim.