| Form | Description | DOC | Fee | |
|---|---|---|---|---|
| Form 12A | First Report of Injury | Doc | No fee | |
| Form 12M | Annual Minor Medical Report | Doc | No fee | |
| Form 14A | Health Insurance Claim Form | Word Format not Available |
No fee | |
| Form 14B | Physician's Statement | Doc | No fee | |
| Form 15 | Temporary Compensation Report | Doc | $50.00 for Section III only |
|
| Form 15S | Supplemental Report of Varying Temporary Partial Payments |
Doc | No fee | |
| Form 16 | Agreement for Permanent Disability/Disfigurement Compensation |
Doc | $50.00 if filed by Claimant's Attorney |
|
| Form 16A | Agreement for Permanent Disability/Disfigurement Compensation Please complete this form for injuries occurring after July 1, 2007 |
Doc | $50.00 if filed by Claimant's Attorney |
|
| Form 17 | Receipt of Compensation | Doc | No fee | |
| Form 18 | Periodic Report | Doc | No fee | |
| Form 19 | Saturation Report and Compensation Report | Doc | No fee | |
| Form 20 | Statement of Earnings of Injured Employee | Doc | No fee | |
| Form 24 | Application for Lump Sum Award | Doc | $50.00 | |
| Form 50 | Employee's Notice of Claim and or Request for Hearing |
Doc | $50.00 for Request for Hearing only |
|
| Form 52 | Employee's Notice of Claim and/or Request for Hearing, Death Case |
Doc | $50.00 for Request for Hearing only |
|
| Form 53 | Employer's Answer to Request for Hearing, Death, Case |
Doc | No Fee | |
| Form 61 | Attorney Fee Petition | Doc | No fee | |
| Form S-1 | Notice of Third Party Action Employee Carrier | Doc | No fee | |
| Form S-2 | Notice of Third Party Action Employee | 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.