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The Official Web Site of the State of South Carolina

The South Carolina Workers' Compensation Commission Offices will be closed tomorrow, September 30, 2022, due to inclement weather. 

 

Website under construction. Please pardon our appearance while we update the information on our website.

 

Self-Insurance Forms

The South Carolina Workers’ Compensation Commission offers the following forms applicable to self-insurance procedures. 

If you require assistance, please contact the Self-Insurance Division

Self-Insurance Division
Telephone: 803-737-5706
Fax: 803-737-1258
self-insurance@wcc.sc.gov

 

6

Application to Create a Self-Insurance Fund

PDF

Doc

$250.00

6A

Application for Membership in a Self-Insured Fund

PDF

 

$25.00

7

Application to Individually Self-Insure

PDF

Doc

$250.00 plus $100.00 for each subsidiary

7A

Corporate Guaranty

PDF

Doc

No fee

8

SC Workers’ Compensation Commission Bond Required of
Employer Carrying His Own Risk

PDF

Doc

No fee

8B

Irrevocable Letter of Credit

PDF

Doc

No fee

10

South Carolina Self-Insurance Tax Form

PDF

 

No fee

11

Fund Quarterly Financial Report

PDF

Doc

No fee