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The Official Web Site of the State of South Carolina
Regulation 67-1602 has been amended to establish electronic payment systems as the default method of payment for temporary disability and reimbursement for expenses. The full advisory and text of the regulation may be accessed here.

 

 

Claimant Forms

Form Description PDF Doc Fee
16 Agreement for Permanent Disability/ Disfigurement Compensation PDF Doc $50.00 if Claimant Represented
16A

Agreement for Permanent Disability/ Disfigurement Compensation (injuries after July 1, 2007)

PDF Doc $50.00 if Claimant Represented
17 Receipt of Compensation PDF Doc No Fee
20 Statement of Earning of Injured Employee PDF Doc No Fee
24 Application for Lump Sum Award PDF Doc $50.00
27 Subpoena PDF Doc No Fee
30 Request for Commission Review (Appellate Panel Review) PDF Doc $150
32 Request to Waive Filing Fee PDF Doc No Fee
50 Employee's Notice of Claim or Hearing Request PDF Doc $50/ Hearing Request only
52 Employee's Notice of Claim or Hearing Request (Death Claim) PDF Doc $50.00/ Hearing Request only
58 Pre-Hearing Brief PDF Doc No Fee
59 Appellant's Informational Brief PDF Doc No Fee
65 Occupational Disease Waiver PDF Doc No Fee
S-2 Notice of Third-Party Action (Employee) PDF Doc No Fee
  Single Commissioner Decision & Order Template   Doc No Fee
  Appellate Panel Decision & Order Template   Doc No Fee
  Certificate of Service   Doc No Fee