South Carolina Workers’ Compensation Forms

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 PDF No Fee
Form 6 Application to Create a Self-Insurance Fund PDF $250.00
Form 6A Application for Membership in a Self-Insured Fund PDF $25.00
Form 7 Application to Individually Self-Insure PDF $250.00 plus $100.00 for each subsidiary
Form 7A Corporate Guaranty PDF No fee
Form 8 SC Workers’ Com. Comm. Bond Required of Employer Carrying His Own Risk PDF No fee
Form 8B Irrevocable Letter of Credit PDF No fee
Form 10 South Carolina Self-Insurance Tax Form (for calculations, Java scripting must be enabled in Adobe Reader) PDF No fee
Form 11 Fund Quarterly Financial Report PDF No fee
Form 12A First Report of Injury PDF No fee
Form 12M Annual Minor Medical Report PDF No fee
Form 14A Health Insurance Claim Form PDF No fee
Form 14B Physician’s Statement PDF No fee
Form 15 Temporary Compensation Report PDF $25.00 for Section III only
Form 15S Supplemental Report of Varying Temporary Partial Payments PDF No fee
Form 16 Agreement for Permanent Disability/ Disfigurement Compensation PDF $25.00 if Claimant is represented
Form 16A Agreement for Permanent Disability/ Disfigurement Compensation For injuries occurring after July 1, 2007. PDF $25.00 if Claimant is represented
Form 17 Receipt of Compensation PDF No fee
Form 18 Periodic Report PDF No fee
Form 19 Status Report and Compensation Receipt PDF No fee
Form 20 Statement of Earning of Injured Employee PDF No fee
Form 21 Employer’s Request for Hearing PDF $25.00
Form 22 Claimant’s Answer to Request for A Hearing PDF No fee
Form 24 Application for Lump Sum Award PDF $25.00
Form 27 Subpoena PDF No fee
Form 30 Request for Commission Review PDF $150.00
Form 32 Request to Waive Appeal Filing Fee PDF No fee
Form 33 Hearing Postponed PDF No fee
Form 38 Employer’s Withdrawal of Election to Adopt the South Carolina Workers’ Compensation Act PDF No fee
Form 39 Coverage Coding Sheet PDF No fee
Form 50 Employee’s Notice of Claim and or Request for Hearing PDF $25.00 for Request for Hearing only
Form 51 Employer’s Answer to Request for Hearing PDF No fee
Form 52 Employee’s Notice of Claim and/or Request for Hearing PDF $25.00 for Request for Hearing only
Form 53 Employer’s Answer to Request for Hearing, Death Case PDF No fee
Form 54 Employer’s Notice of Claim and/or Request for Hearing PDF $25.00
Form 55 Second Injury Fund’s Answer to Employee’s Request for Hearing PDF No fee
Form 58 Pre-Hearing Brief PDF No fee
Form 59 Appellant’s Informal Brief PDF No fee
Form 61 Attorney Fee Petition PDF No fee
61 Order Attorney Fee Petition PDF No fee
61A Attorney Fee Petition Supplemental Information PDF No fee
Form 65 Occupational Disease Waiver PDF No Fee
Form 70 (Effective July 2013) Mediator Report PDF No fee
Form S-1 Notice of Third Party Action Employee Carrier PDF No fee
Form S-2 Notice of Third Party Action Employee PDF No fee
Form S-3 Entitlement to Right of Action PDF No fee
Form S-4 Court Certificate PDF No fee

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Results

WE HAVE RECOVERED OVER $500 MILLION FOR CLIENTS IN THE LAST 10 YEARS, 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

They have amazing lawyers!

They have worked on an impossible situation and exceeded all expectations in the resulting settlements. I would recommend the Steinberg Law Firm to anyone and everyone!

My experience was excellent

From the first consultation to the end of my case I was kept updated step by step. My attorney worked hard for me and got me more than what I expected.

I never felt like I was alone

My lawyer and his Paralegal were right with me the entire case. I never felt like I was alone. At every turn they were in my corner. Someone recommended me to Steinberg law firm and I gladly would do the same for someone else.

I couldn't have asked for better

The people from the Steinberg group are top-notch. They handled my case extremely well, I couldn’t have asked for a better performance. Thank you all so much for all you did for me.

I am grateful for them!

At my worst, they honestly and carefully protected and defended my family on multiple levels. I’m a client for life and the integrity of this law firm is unmatched. Thank You Steinberg Law Family!!!

The people are thoughtful and professional

Questions and concerns always get answered and concerns are taken care of. Thank you all at Steinburg for a good experience and for showing me that you care about your clients.

The best law firm

This the best law firm anyone could ever deal with. Mr. Pearlman will work hard to get everything that is owed to you. It was a pleasure to have been represented by this firm.

A wonderful experience

Had a wonderful experience with Mr. Pearlman and his team. Thank you very much for your diligence and expertise.

I highly recommend them

They work as a team providing the best referrals and assistance to accomplish what my family and I needed. I highly recommend them because you won’t be disappointed.