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South Carolina Form Center -

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Each form may be downloaded in Adobe Acrobat format. Download the form by clicking on the form number below.
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Form

Description

form12a.pdf First Report of Injury
form5.pdf Corporate Officer Notice to Reject
form6.pdf Application to Create a Self-Insurance Fund
form6a.pdf Application for Membership in a Self-Insured Fund
form7.pdf Application to Individually Self-Insure
form7a.pdf Corporate Guaranty
form8.pdf SC Workers Com. Comm. Bond Required of Employer Carrying His On Risk
form8b.pdf Irrevocable Letter of Credit
form10.pdf South Carolina Self-Insurance Tax Form
form11.pdf Fund Quarterly Finacial Report
form12m.pdf Annual Minor Medical Report
form14a.pdf Health Insurance Claim Form (HCFA-1500; OWCP 1500; RRB 1500)
MDB.pdf Initial Medical Bill Dispute Form
form14b.pdf Physician's Statement
form15.pdf Temporary Compensation Report
form15s.pdf Supplemental Report of Varying Temporary Partial Payments
form16.pdf Agreement for Permanent Disability / Disfigurement Compensation
form16a.pdf Agreement for Permanent Disability/ Disfigurement Compensation (This form is only applicable to injuries by accident occurring on or after July 1, 2007)
form17.pdf Receipt of Compensation
form18.pdf Periodic Report
form19.pdf Status Report and Compensation Receipt
form20.pdf Statement of Earnings of Injured Employee
form21.pdf Employer's Request for Hearing
form22.pdf Claimant's Answer to Request for Hearing
form24.pdf Application for Lump Sum Award
form27.pdf Subpoena
form30.pdf Request for Commission Review
form32.pdf Request to Waive Appeal Filing Fee
form33.pdf Hearing Postponed
form38.pdf Employer's Withdrawal of Election to Adopt the South Carolina Workers' Compensation Act
form39.pdf Coverage Coding sheet for Attorneys
form50.pdf Employee's Notice of Claim and/or Request for Hearing
form51.pdf Employers Answer to Request for Hearing
form52.pdf Employee's Notice of Claim and/or Request for Hearing (Death Case)
form53.pdf Employers Answer to Request for Hearing, Death Case
form54.pdf Employers Notice of Claim and/or Request for Hearing
form55.pdf Second Injury Fund's Answer to Employer's Request for Hearing
form58.pdf Pre-hearing Brief
form59.pdf Appellant's Informal Brief
form61.pdf Attorney Fee Petition
form61c.pdf Order Approving Attorney Fee
form61a.pdf Attorney Fee Petition (Query)
form65.pdf Occupational Disease Waiver
form70.pdf Mediator Report
form-s1.pdf Notice of Third Party Action, Employee Carrier
form-s2.pdf Notice of Third Party Action, Employee
form-s3.pdf Entitlement to Right of Action
form-s4.pdf Court Certificate
WorkersComp.pdf POSTER - Workers' Compensation
releasedata.pdf Authorization of Release of Claims Data