South Carolina Workers’ Compensation Forms
The South Carolina Workers’ Compensation Commission offers all of its necessary forms in Word and PDF fillable format on their website at https://www.wcc.sc.gov. For the convenience of our clients, we have provided those exact same workers’ compensation forms here on our website. You can download and fill them out or print and complete them manually.
If you have questions or need assistance with any of these forms, please contact the Steinberg Law Firm at 843-720-2800. We highly recommend that you do not attempt to complete these forms without the guidance of an experienced workers’ compensation attorney.
| Form # | Name | Download | Filing Fee |
| Form 5 | Corporate Officer Notice to Reject | No Fee | |
| Form 6 | Application to Create a Self-Insurance Fund | $250.00 | |
| Form 6A | Application for Membership in a Self-Insured Fund | $25.00 | |
| Form 7 | Application to Individually Self-Insure | $250.00 plus $100.00 for each subsidiary | |
| Form 7A | Corporate Guaranty | No fee | |
| Form 8 | SC Workers’ Com. Comm. Bond Required of Employer Carrying His Own Risk | No fee | |
| Form 8B | Irrevocable Letter of Credit | No fee | |
| Form 10 | South Carolina Self-Insurance Tax Form (for calculations, Java scripting must be enabled in Adobe Reader) | No fee | |
| Form 11 | Fund Quarterly Financial Report | No fee | |
| Form 12A | First Report of Injury | No fee | |
| Form 12M | Annual Minor Medical Report | No fee | |
| Form 14A | Health Insurance Claim Form | No fee | |
| Form 14B | Physician’s Statement | No fee | |
| Form 15 | Temporary Compensation Report | $25.00 for Section III only | |
| Form 15S | Supplemental Report of Varying Temporary Partial Payments | No fee | |
| Form 16 | Agreement for Permanent Disability/ Disfigurement Compensation | $25.00 if Claimant is represented | |
| Form 16A | Agreement for Permanent Disability/ Disfigurement Compensation For injuries occurring after July 1, 2007. | $25.00 if Claimant is represented | |
| Form 17 | Receipt of Compensation | No fee | |
| Form 18 | Periodic Report | No fee | |
| Form 19 | Status Report and Compensation Receipt | No fee | |
| Form 20 | Statement of Earning of Injured Employee | No fee | |
| Form 21 | Employer’s Request for Hearing | $25.00 | |
| Form 22 | Claimant’s Answer to Request for A Hearing | No fee | |
| Form 24 | Application for Lump Sum Award | $25.00 | |
| Form 27 | Subpoena | No fee | |
| Form 30 | Request for Commission Review | $150.00 | |
| Form 32 | Request to Waive Appeal Filing Fee | No fee | |
| Form 33 | Hearing Postponed | No fee | |
| Form 38 | Employer’s Withdrawal of Election to Adopt the South Carolina Workers’ Compensation Act | No fee | |
| Form 39 | Coverage Coding Sheet | No fee | |
| Form 50 | Employee’s Notice of Claim and or Request for Hearing | $25.00 for Request for Hearing only | |
| Form 51 | Employer’s Answer to Request for Hearing | No fee | |
| Form 52 | Employee’s Notice of Claim and/or Request for Hearing | $25.00 for Request for Hearing only | |
| Form 53 | Employer’s Answer to Request for Hearing, Death Case | No fee | |
| Form 54 | Employer’s Notice of Claim and/or Request for Hearing | $25.00 | |
| Form 55 | Second Injury Fund’s Answer to Employee’s Request for Hearing | No fee | |
| Form 58 | Pre-Hearing Brief | No fee | |
| Form 59 | Appellant’s Informal Brief | No fee | |
| Form 61 | Attorney Fee Petition | No fee | |
| 61 Order | Attorney Fee Petition | No fee | |
| 61A | Attorney Fee Petition Supplemental Information | No fee | |
| Form 65 | Occupational Disease Waiver | No Fee | |
| Form 70 (Effective July 2013) | Mediator Report | No fee | |
| Form S-1 | Notice of Third Party Action Employee Carrier | No fee | |
| Form S-2 | Notice of Third Party Action Employee | No fee | |
| Form S-3 | Entitlement to Right of Action | No fee | |
| Form S-4 | Court Certificate | No fee |
Practice Areas
Results
WE HAVE RECOVERED OVER $1 BILLION FOR CLIENTS, INCLUDING:
Leaders in the Legal Industry
Steinberg attorneys have been awarded numerous distinctions, such as Super Lawyers, Best Lawyers in America by U.S. News & World Report, Gedney M. Howe, Jr. Award for Outstanding Public Service, the SC Leadership in Law award, and has been voted Best Workers’ Comp Firm in SC, among other distinctions.
What Our Clients Say
I would highly recommend them.
I would highly recommend them. Enjoyed the fact that every time I called, someone called me back. It made me feel like my case mattered, and that I mattered. They answered all of my questions and concerns in a timely manner.
- Paula
I am very pleased with my experience.
I am very pleased with my experience. I have and will continue to recommend the Steinberg Law Firm. They have worked very hard on my behalf.
- Sharon
Received a significant settlement.
Received a significant settlement. Ms. Andrews is very communicative and will fight for your case.
- Tiera Green
Taylor and his team did an amazing job
I was involved in an auto accident in 2021, and chose Steinberg Law Firm to represent my case. Taylor and his team did an amazing job representing me in my case. They were super nice, kept me up-to-date, answered any questions in a timely manner, and settled my case quickly. I highly recommend Taylor Grooms and his team.
- Mary Lowe
He didn't give up.
We work hard through the pandemic to get the case solved and it was a tuff fight but in all he didn’t give up. I definitely would call Lawrence Grooms again if I need him
- Shannon
Mr. Taylor Grooms is very professional...
Mr. Taylor Grooms is very professional and have great customer service. He made everything so easy.
- Kimberly
A team who exemplify extraordinary integrity, value, and work ethic.
Immediately after my auto accident. Mr. Taylor Grooms, Attorney and Ms. Glenis Haynes, Paralegal were compassionate and responsive to my inquiry. They are available by phone, text, and email proactively letting me know the status of my case. Mr. Grooms was direct letting me know the pros and cons concerning my outcome. Ms. Glenis was a phone call or text away when I had question. A team who exemplify extraordinary integrity, value, and work ethic. I am highly recommending Taylor and Glenis for their commitment to excellence.
- Dr. M. Frazier
Elliotte Quinn is a definite go-to for construction issues.
After a long suit over my home, we prevailed. Elliotte Quinn is a definite go-to for construction issues. Extremely detailed and easy to work with toward the goal. Highly suggested.
- M. Durante
Elliott and his assistant, Monica, were both amazing!
Elliott and his assistant, Monica, were both amazing! They explained exactly what to expect and when, and got us a great settlement. I highly recommend this law firm!