| Form # | Description | DOC | Filing Fee | |
|---|---|---|---|---|
| 12A |
First Report of Injury |
Doc | No fee | |
| 12M | Annual Minor Medical Report | Doc | No fee | |
| 14A | Health Insurance Claim Form | Doc Format Not Available |
No fee | |
| 15 | Temporary Compensation Report | Doc | $50.00 for Section III only | |
| 15S | Supplemental Report of Varying Temporary Partial Payments | Doc | No fee | |
| 16 | Agreement for Permanent Disability / Disfigurement Compensation | Doc | $50.00 if Claimant is represented | |
| 16A |
Agreement for Permanent Disability / Disfigurement Compensation Please complete this form for injuries occurring after July 1, 2007. |
Doc |
$50.00 if Claimant is represented |
|
| 17 |
Receipt of Compensation |
Doc | No fee | |
| 18 | Periodic Report | Doc | No fee | |
| 19 | Status Report and Compensation Receipt | Doc | No fee | |
| 20 | Statement of Earning of Injured Employee | Doc | No fee | |
| S-1 |
Notice of Third Party Action Employee Carrier |
Doc | No fee | |
| S-3 |
Entitlement to Right of Action |
Doc | No fee | |
| S-4 |
Court Certificate |
Doc | No fee |
The Official Web Site of the State of South Carolina
On May 8, 2025, the Senate confirmed the reappointment of Commissioners Beck, Campbell, and McCaskill. We congratulate each of them on their confirmation and thank them for their continued dedication and service. Read more here.
The South Carolina Workers’ Compensation Commission is pleased to welcome Commissioner John Gabriel “Gabe” Coggiola, who has been appointed to serve the unexpired term of former Commissioner Avery B. Wilkerson, Jr., from July 1, 2020, through June 30, 2026. Read more here.