Вы находитесь на странице: 1из 43
 
PS-4 (REV. 12/15)
COMMONWEALTH OF PENNSYLVANIA
INSURANCE COMPLAINT FORM
 (PLEASE TYPE OR PRINT) It is our goal to assist you in resolving your complaint as quickly as possible. Therefore, we ask that you complete this form and return it to the office listed on the reverse side of this page. Please provide as much information and documentation as you can. Within a few days following our receipt of your complaint, you will receive a letter advising you of your file number, the name of the investigator assigned to assist you and information on how to contact our office if you have questions. In general, you can expect the investigator to contact you within thirty (30) days to advise you of our findings or the status of our review.
DAYTIME TELEPHONE HOME: (_____)_________________________ 
 
WORK: (_____)_________________________ EMAIL: ________________________________
1.
 
Does this complaint involve an individual that is Medicare eligible?
(Y/N)
 2.
 
Type of
Auto
Individual Life Individual Health
Medicare Supplement
 Insurance: Homeowners Group Life
Group Health
 Long Term Care
Renters/Cond o
Annuity HMO Commercial Viatical Medicaid Flood Medicare Title Medicare Advantage 3. Type of
Cancellation/Nonrenewal Claim Handling Billing/Premium Dispute
 Problem:
Sales Misrepresentation Other (specify) _____________________________________ 
 4. (A) If your problem involves an insurance company, give the full name of the company: (B)
 
If your problem involves an agent or broker, give his/her full name, address and phone number. 5. Policy Number: ________________________ In what State was this policy sold? ________________ 6. Date & location of loss: __________________________ Claim #: ______________________________ 7. Have you previously reported this problem to our office or any other agency?
Yes No  NAME: ADDRESS:
 
 _____________________________________________
INSURED’S
 
 NAME:
 
(IF
 
OTHER 
 
THAN
 
THE
 
ABOVE)
 
:
 
 __________________________________________________________ INSURANCE CARD ID NUMBER:
 
 
GIECO INSURANCE COMPLAINTPage No. 1 of 43Thursday September 7, 2017
STAN J. CATERBONE, PRO SE - LANDMARK CIVIL RIGHTS AND ANTI-TRUST CASE
STAN J. CATERBONE
1250 FREMONT STREET
717
327-1566
LANCASTER, PA 17603
14138XN
X
GEICO INSURANCE COMPANY4430-72-86-85PENNSYLVANIA
X
 
PS-4 (REV. 12/15) 8.
 Are you represented by an attorney? Yes No If yes, please give name, address and telephone #:  Note: If you have proceeded with litigation against the company and/or agent we will not be able to assist you until the litigation has been completed and the court has found misconduct on the part of these parties.
9. Briefly describe your problem and state how you feel it should be resolved. Copies of your policy, correspondence or other supporting documentation will assist us in understanding or evaluating the issues, please include this documentation with your complaint form. If more space is needed to describe your problem, please attach additional sheets.
PLEASE READ, SIGN AND DATE THE STATEMENT BELOW:
I CERTIFY THAT THE INFORMATION THAT I HAVE GIVEN ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT A COPY OF THIS FORM AND ATTACHMENTS MAY BE FORWARDED TO THE INSURANCE COMPANY, AGENT OR BROKER INVOLVED. (Signature) (Date)
(IF YOUR COMPLAINT INVOLVES A MEDICAL ISSUE AND/OR CREDIT INFORMATION) Please circle either Medical Issue, Credit Information or Both.
I AUTHORIZE__________________________________ (Name of Insurance Company) TO RELEASE TO THE PENNSYLVANIA INSURANCE DEPARTMENT ANY
MEDICAL OR CREDIT INFORMATION
 THAT MAY BE PERTINENT TO THE RESOLUTION OF MY COMPLAINT. (Signature) (Date)
 Mail or Fax Complaint Form to:
Pennsylvania Insurance Department Bureau of Consumer Services Room 1209, Strawberry Square Harrisburg, PA 17120 Fax: (717) 787-8585
Toll Free Consumer Hotline: 1-877-881-6388 Please feel free to submit your question or complaint on-line at: Website: www.insurance.pa.gov 
 
GIECO INSURANCE COMPLAINTPage No. 2 of 43Thursday September 7, 2017
STAN J. CATERBONE, PRO SE - LANDMARK CIVIL RIGHTS AND ANTI-TRUST CASE
X
SEE ATTACHED SHEETS
 
Stan J. CaterboneADVANCED MEDIA GROUP
Freedom From Covert Harassment & Surveillance,
®
Registered in Pennsylvania
1250 Fremont StreetLancaster, PA 17603www.amgglobalentetainmentgroup.comstancaterbone@gmail.com717-327-1566
STATEMENTPENNSYLVANIA INSURANCE DEPARTMENT COMPLAINT re Geico NOTICE OF CANCELLATION OR REFUSAL TO RENEW SEPTEMBER 7, 2017 _______________________________ 
2 DVD DISCS ENCLOSED TO SUBSTANTIATE THE FOLLOWING ____________________ 
1.
THE GEICO INSURANCE POLICY HAS SEEN A NEARLY 100% RISE IN PREMIUMS SINCE THE 2016 POLICY RENEWAL DATE MAINLY DUE TO THE CIVIL/CRMINAL MALICIOUS AND FALSE PROSECUTION BY THE LANCASTER CITY POLICE DEPARTMENT.
2.
GEICO INSURANCE ALSO REFUSES TO HONOR THE HOMEOWNERS POLICY THAT HAS RESULTED IN OVER $10,000.00 WORTH OF DAMAGES AND LOST SAVINGS DUE TO THE SAME.
3.
THE FOLLOWING VIOLATIONS HAVE TAKEN PLACE:
A.
CIVIL/CRIMINAL CONSPIRACY IN THE FACT THAT THE FALSE STATEMENTS WERE TAKEN ON MAY 10, 2017 YET THE CHARGES WERE NOT FILED UNTIL JUNE 15, 2017 IN ORDER TO PROVIDE THE COURT DOCKETS WITH CRIMINAL CHARGES AGAINST COMPLAINTANT CATERBONE DURING THE TIME INWHICH MAJOR LITIGATION IS NEARING DECISIONS AGAINST THE LANCASTER CITY POLICE IN FEDERAL AND STATE COURTS WHERE THEY ARE LISTED AS DEFENDANTS IN REGARDS TO NUMEROUS CIVIL/CRIMINAL ACTIONS.
B.
LIBLE AND SLANDER 
C.
OBSTRUCTION OF JUSTICE, TAMPERING WITH A WITNESS
D.
HARASSMENT AND BATTARY
E.
CONTINUING AND FACILITATING THE HARASSMENT AND THREAT PROGRAM OF 1252 FREMONT STREET THAT HAS BEEN ONGOING SINCE2006
F.
CONTINUING THE COINTELPRO HARASSMENT AND OBSTRUCTION OF JUSTICE PROGRAM OF LOCAL LAW ENFORCEMENT
G.
PROTECTING PERPETRATORS FROM ENTERING THE COMPLAINTANT STAN J. CATERBONE'S RESIDENCE IN ORDER TO VANDALIZE AND STEAL CONTENTS CAUSING SEVERE FINANCIAL LOSSES AND AIDING IN THE LIBEL AND SLANDER CAMPAIGN.
GIECO INSURANCE COMPLAINTPage No. 3 of 43Thursday September 7, 2017
STAN J. CATERBONE, PRO SE - LANDMARK CIVIL RIGHTS AND ANTI-TRUST CASE

Вознаградите свое любопытство

Все, что вы хотели прочитать.
Когда угодно. Где угодно. На любом устройстве.
Без обязательств. Отменить можно в любой момент.
576648e32a3d8b82ca71961b7a986505