| 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
The South Carolina Workers’ Compensation Commission has issued an advisory notice updating the authorization for release of claims information form. The new form can be accessed here.