This document is a sample consumer application filed with the District Consumer Disputes Redressal Forum concerning a Mediclaim insurance policy. It details a case where a policyholder's cashless claim was rejected by the insurance company, leading to out-of-pocket expenses for hospitalisation. The application outlines the grounds for dispute, including the necessity of treatment and the insurance company's repudiation of the claim. It is useful for individuals facing similar issues with their health insurance claims and seeking legal recourse.