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What Are the Different Work Comp Forms and When do They Need to Be Filed?

An Overview of Workers' Compensation Forms in South Carolina

The forms are published by the Workers' Compensation Commission. Packets of originals are available from the Commission on request. The packet includes an overview of the forms, highlights the most often used and the most important form and explains there usage. Most are self-explanatory and most reference the relevant regulations on the bottom margin.

  • Form 12-A –Must be filed within ten (10) days of reported accident/injury unless costs are under $2,500 and employee loses no time from work.
  • Form 12-M –medicals only reported injury
  • Form 14 –Physician's Report and Itemized Statement (prepared by Doctor's office for approval of fees).
  • Form 15 –Temporary Compensation Report
    • Section I—filed ten (10) days after compensation begins; Section II –filed then (10) days after compensation is terminated; Section III –Claimant's request for hearing
    • Form 15S –Supplemental Report of Varying Temporary Partial Payments –filed when temporary compensation varies from week -to –week (six months after initial compensation begins).
  • Form 16 – Supplemental Agreement for Compensation – filed when settlement is reached (other than Clincher).
  • Form 17 – Receipt of Compensation – you may ask employee to sign this form fifteen (15) days after employee returns to work or agrees he can return to work. It can be signed when the "claimant returned to work without restriction," or "claimant agrees that he/she was able to return to work."
  • Form 18 – Six (6) Month Report – required to be filed with Commission every six (6) months while claim is open to verify all compensation is current. Completed copy must always accompany Form 21.
  • Form 19 – Status Report and Compensation Receipt –verifies the amount of compensation paid; must be filed when claim is denied or settled on a Form 16 or Clincher Agreement. This is a receipt showing that all payments due under the Clincher have been paid to the employee and the matter has been resolved.
  • Form 20 – Statement of Days Worked and Earnings of Injured Employee (Wage Calculation)– must be completed and submitted within thirty (30) days after notice of injury or within thirty (30) days after receipt of Form 50, claimant's hearing request. Used to determine compensation rate.
  • Form 21– Employer's Request for Hearing – filed with Form 18 and other appropriate documents as noted on the form. Used to stop or reduce payment of temporary compensation or pay permanent disability after a claimant reaches maximum medical improvement.
  • Form 30 – If an employer or employee is not happy with the decision of a commissioner at a contested hearing, either or both parties may appeal the Commissioner's decision. An initial appeal is made pursuant to a Form 30 filed with the Commission. It must be filed within fourteen (14) days of the losing party receiving a copy of the Commission's Order. Appeals from the Full Commission are made to the Circuit Court of the County in which the accident occurred. Decisions of the Circuit Court may be appealed to the South Carolina Supreme Court.
  • Form 50 – Claimant's Notice of Claim and Request for Hearing – claimant must file Form 50 within two (2) years of the date of injury.
  • Form 51 – Employer's Answer to Request for Hearing – must be filed within thirty (30) days after receipt of claimant's request for hearing.
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