JOSEPH F. BATAILLON, U.S.D.J.
Before me is the motion, Filing No. 1, of Leo J. Racine for a temporary restraining order and preliminary injunction. The motion is supported by an index of evidence, Filing No. 2, and several affidavits, Filing Nos. 3-6. The defendants ("Infinia") submitted a responsive brief. The court held a hearing on the motion on September 11, 2001.
Racine seeks to enjoin Infinia from applying an annual or total contract benefit maximum with respect to otherwise reimbursable medical expenses he incurred on or after April 1, 2001. Racine alleges that as an employee of the defendant Infinia Health Care, he elected coverage under one of Infinia's three health insurance plans based on written descriptions of the plans Infinia provided to him on March 16, 2001. He alleges that the descriptions of the "gold" and "silver" plans did not contain annual reimbursement maximums; the description of the "bronze" plan, however, showed a $7500 annual reimbursment maximum. In reliance on these descriptions, Racine elected to begin coverage under the gold plan on April 1, 2001, and let lapse the COBRA health coverage he had had in connection with his former employment.
On April 1, 2001, Racine was admitted to St. Joseph's Hospital in Omaha, Nebraska with heart problems. Over the course of the next few days, Racine underwent several cardiac surgical procedures, which resulted in nearly $200,000 in medical expenses. Racine now requires several medications for his heart condition, as well as for his depression, acute acid reflux, and severe restless leg syndrome. Infinia, however, has refused to reimburse any more than $75,000 of Racine's medical expenses on the ground Infinia's medical plan limits annual benefits to $75,000.
Racine contends that he first learned in May 2001 that plan benefits might be limited when Infinia distributed a memorandum reminding plan participants that under the gold or silver plans, "your maximum benefit per person is $75,000 per person per year." In June 2001, Racine received a plan document and summary plan description which he alleges amended the plan to impose retroactively the $75,000 annual benefit limit.
In early July, Racine learned that the defendant's health care plan refused to reimburse his medical expenses beyond the alleged $75,000 annual benefit limit. According to an affidavit provided by a verification clerk at St. Joseph's Hospital, however, Infina did not state that any annual plan limits were in effect on April 2, 2001, when the clerk contacted plan administrators to verify Racine's coverage; the only limit identified to the clerk was a $1 million lifetime benefit maximum. Filing No. 5.
Racine has filed a Chapter 13 bankruptcy petition. Without health coverage beyond the $75,000 limit, he cannot pay for the many medications he needs. According to an affidavit filed by Racine's cardiac surgeon, Racine could face serious, even life-threatening consequences from suddenly discontinuing his medications. Filing No. 4 at 2.
Over Infinia's objection that the court lacks jurisdiction because plaintiff has not filed a "complaint" as required by Federal Rule of Civil Procedure 3, the court first finds that Racine's verified motion for a temporary restraining order and temporary injunction, Filing No. 1, along with accompanying index of evidence and affidavits, Filing Nos. 2-6, are sufficient to have notified Infinia of the basis of his claim. The court further finds that Racine shall have leave to later amend the pleadings should the parties be unable to fully resolve Racine's claims in subsequent ERISA administrative proceedings, necessitating a return to this court.
In determining whether to issue a preliminary injunction, the court must consider four factors: 1) the threat of irreparable harm to the movant; 2) the balance between such harm and the injury that granting an injunction will inflict on other parties to the litigation; 3) the likelihood of success on the merits; and 4) the public interest. Dataphase v. C.L. Sys., 640 F.2d 109, 114 (8th Cir. 1981 ) (en banc). Based on the parties' briefs and the arguments presented at the hearing, the court finds that Racine will suffer irreparable harm, perhaps even death, if he is unable to continue taking his prescribed medications. Any harm to Infinia from continuing to cover Racine's prescriptions until the underlying ERISA litigation is concluded is minimized by Racine's promise made through counsel at the hearing to repay any benefits subsequently determined to have been improperly conferred. Further, the court finds that if the facts are substantially as presented in Racine's moving papers, he is likely to succeed on the merits of his claims that Infinia induced him to his detriment to become a participant in its gold plan, but then later attempted to retroactively amend the terms of the plan, again to Racine's detriment. Finally, given the seriousness of the threat to Racine's health should he not received medication, the public interest is served by requiring Infinia to provide Racine with health coverage under the terms of the gold plan pending the outcome of the underlying claims.
Therefore, to provide Racine with coverage for his prescription medications until the parties can resolve the underlying ERISA claims, Infinia is ordered to provide Racine with health coverage under Infinia's "gold" plan, including the $75,000 annual benefits limit, as of June 15, 2001 — roughly the date on which Racine concedes he received the plan document and summary plan description — until such time as the parties have resolved Racine's underlying ERISA claim. This court is not at present the proper forum to resolve Racine's claims from April 1, 2001 — the date plaintiff became covered until Infinia's plan — until May 25 since Racine has not yet pursued any of his ERISA administrative remedies.
As agreed by the parties at the hearing, Racine's promise to repay any benefits later determined to have been improperly conferred shall operate as the security contemplated by Federal Rule of Civil Procedure 65(c). Accordingly,
IT IS THEREFORE ORDERED:
1. Racine's motion, Filing No. 1, for a temporary restraining order and preliminary injunction is granted.
2. Infinia is ordered to provide Racine with health coverage under Infinia's "gold" plan, including the $75,000 annual benefits limit, as of June 15, 2001, and continuing until such time as the parties have resolved Racine' s underlying ERISA claim.
3. Racine's promise to repay any benefits later determined to have been improperly conferred shall operate as the security contemplated by Federal Rule of Civil Procedure 65(c).