Blue Cross of Georgia/Columbus, Inc. v. Whatley

I concur in the judgment only, with respect to Divisions 1 and 4. As to the other divisions, I agree with all that is said.

As to Division 1, there was a question as to whether the 80% or 100% provision of the policy would apply. This could not be resolved merely by reading the contract but required evidence as to whether the insured had paid the first $5,000 in expenses so that he would be entitled to 100% rather than just 80% reimbursement on the claim for nursing care. Since the jury awarded 100%, it would have had to find that insured had already incurred $5,000 in expenses before…