The Official Web Site of the State of South Carolina

The Commission will conduct the monthly Business Meeting Monday, August 25, 2025, at 10:30AM in Hearing Room A at the Commission offices in Columbia. Participants may access the meeting online. The agenda and zoom link may be accessed here.

 

Advisory Notice: On August 25, 2025 Executive Director; Gary M. Cannon Announces Retirement. The full notice may be accessed here.

 

Claims Forms

FormDescriptionPDFDOCFee
Form 12AFirst Report of InjuryPDF DocNo fee
Form 12MAnnual Minor Medical ReportPDFDocNo fee
Form 14AHealth Insurance Claim FormPDFWord Format
not Available		No fee
Form 14BPhysician's StatementPDF DocNo fee
Form 15Temporary Compensation ReportPDF Doc$50.00 for
Section III only
Form 15SSupplemental Report of Varying
Temporary Partial Payments    		PDFDocNo fee
Form 16Agreement for Permanent
Disability/Disfigurement Compensation		PDFDoc$50.00 if filed by
Claimant's Attorney
Form 16AAgreement for Permanent
Disability/Disfigurement Compensation

Please complete this form for injuries occurring
after July 1, 2007		PDFDoc$50.00 if filed by
Claimant's Attorney
Form 17Receipt of CompensationPDFDocNo fee
Form 18Periodic ReportPDFDocNo fee
Form 19Saturation Report and Compensation ReportPDFDocNo fee
Form 20Statement of Earnings of Injured EmployeePDFDocNo fee
Form 24Application for Lump Sum AwardPDFDoc$50.00
Form 50Employee's Notice of Claim and or Request
for Hearing		PDFDoc$50.00 for Request
for Hearing only
Form 52Employee's Notice of Claim and/or Request
for Hearing, Death Case 		PDFDoc$50.00 for Request
for Hearing only
Form 53Employer's Answer to Request
for Hearing, Death, Case		PDFDocNo Fee
Form 61Attorney Fee PetitionPDFDocNo fee
Form S-1Notice of Third Party Action Employee CarrierPDFDocNo fee
Form S-2Notice of Third Party Action EmployeePDFDocNo fee