SECTION 103.11. Group Term Life Benefit Based on Extended Coverage

(a) A member of the retirement system, who had coverage in the Group Term Life benefit program during the last month the member was required to make a contribution to the retirement system and who dies within 24 calendar months following that month, is considered to have received extended coverage in the Group Term Life benefit program provided that the member was unable to engage in gainful employment or was on leave of absence under the Family and Medical Leave Act of 1993 ("the FMLA") throughout the period beginning with the date of the member's last required contribution and ending on the date of the member's death.

(b) The person making the claim for payment of a Group Term Life benefit based on extended coverage has the burden of establishing that the deceased member was unable to engage in gainful employment or was on leave under the FMLA throughout the entire period of extended coverage, and the claimant must provide evidence satisfactory to the retirement system of that fact.

(c) The following are examples of documents relating to the member that may assist the claimant in meeting this burden of proof:

(1) copy of the decedent's death certificate;

(2) certified statements of attending physicians;

(3) certified statements of caregivers and custodians;

(4) certified statements of subdivisions regarding absences under the FMLA;

(5) certified statements of individuals having personal knowledge of the decedent's education, training and work experience;

(6) copies of the decedent's tax returns covering the period of extended coverage;

(7) findings of the Social Security Administration, Workers Compensation Commission or other entities providing compensation for disability, illness or injury.

(d) In its determination of a claim filed under this section, the retirement system may consider whether the impairment or incapacity affecting the decedent's ability to engage in gainful employment could have been safely diminished by the decedent with reasonable effort to the extent that the decedent would have been able to engage in gainful employment.

Source Note: The provisions of this §103.11 adopted to be effective January 27, 2000, 25 TexReg 390; amended to be effective January 6, 2002, 26 TexReg 11036; amended to be effective December 30, 2012, 37 TexReg 10249