Many Americans have faced the denial of mental health treatment by their insurance companies — at times despite vivid evidence of the risk such decisions pose. In most cases, patients don’t appeal. But in a tiny percentage, patients and their families decide to fight the denials in federal court, setting up a David-versus-Goliath battle where insurers frequently have the upper hand.

The cases, ProPublica found, expose in blunt terms how insurance companies can put their clients’ health in jeopardy, in ways that some judges have ruled “arbitrary and capricious.” To do so, court records reveal, the insurers have turned to a coterie of psychiatrists and have continued relying on them even after one or more of their decisions have been criticized or overturned in court.

In their rulings, judges have found that insurers, in part through their psychiatrists, have acted in ways that are “puzzling,” “disingenuous” and even “dishonest.” The companies have engaged in “selective readings” of the medical evidence, “shut their eyes” to medical opinions that opposed their conclusions and made “baseless arguments” in court. Doctors reviewing the same cases have even repeated nearly identical language in denial letters, casting “significant doubt” on whether they’re independent.