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Employer Forms

Form # Description PDF DOC Filing Fee

16A

Agreement for Permanent Disability / Disfigurement Compensation

Please complete this form for injuries occurring after July 1, 2007.

PDF

Doc

$50.00 if Claimant is represented

17

Receipt of Compensation

PDF

Doc

No fee

18

Periodic Report

PDF

Doc

No fee

19

Status Report and Compensation Receipt

PDF

Doc

No fee

20

Statement of Earning of Injured Employee

PDF

Doc

No fee

21

Employer's Request for Hearing

PDF

Doc

$50.00

27

Subpoena

PDF

Doc

No fee

30

Request for Commission Review

PDF

Doc

$150.00

33

Hearing Postponed

PDF

Doc

No fee

38

Employer’s Withdrawal of Election to Adopt the
South Carolina Workers’ Compensation Act

PDF

Doc

No fee

51

Employer's Answer to Request for Hearing

PDF

Doc

No fee

53

Employer's Answer to Request for Hearing, Death Case

PDF

Doc

No fee

54

Employer's Notice of Claim and/or Request for Hearing

PDF

Doc

$50.00

55

Second Injury Fund's Answer to Employee's Request for Hearing

PDF

Doc

No fee

58

Pre-Hearing Brief

PDF

Doc

No fee

59

Appellant’s Informal Brief

PDF

Doc

No fee

65

Occupational Disease Waiver

PDF

Doc

No fee

70

Mediator Report

PDF

Doc

No fee

S-1

Notice of Third Party Action Employee Carrier

PDF

Doc

No fee

S-3

Entitlement to Right of Action

PDF

Doc

No fee

S-4

Court Certificate

PDF

Doc

No fee