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Top Questions and Answers
File a claim by filling out and submitting Form 50 (in case of work-related injuries) or Form 52 (in case of work-related death) to the Commission. Request a hearing by indicating this desire on the claim form (Line 13b on Form 50 or Line 12b on Form 52).
Related Searches
The South Carolina Workers' Compensation Commission offers all of its forms in PDF fillable format, or that they can be printed out and completed manually. Claims Forms ; Form 14B, Physician's Statement, PDF ; Form 15, Temporary Compensation Report, PDF ; Form 15S, Supplemental Report of Varying Temporary Partial ... Employer Forms ; 21. Employer's Request for Hearing. PDF ; 27. Subpoena. PDF ; 30. Request for Commission Review. PDF ; 33. Hearing Postponed. PDF ; 38. Employer's ... 1. 2. The claimant sustained an injury to (Part(s) of Body Injured) on (Month/Day/Year) in county, state of . Body part(s) affected are: Carrier Forms ; 15S, Supplemental Report of Varying Temporary Partial Payments, PDF ; 16, Agreement for Permanent Disability / Disfigurement Compensation, PDF ... Claimant Forms ; 20, Statement of Earning of Injured Employee, PDF ; 24, Application for Lump Sum Award, PDF ; 27, Subpoena, PDF ; 30, Request for Commission Review ... The updated forms are currently available for download on the Commission website. ... Subpoenas and File Copy Requests · Verify Coverage · eCase · South Carolina ... A copy of this form must be served upon the South Carolina Workers' Compensation Commission, the Workers' Compensation carrier or self-insurer employer by. File this form with the Claims Department according to R.67-414 and R.67-1204. A person, other than the claimant, receiving benefits should sign on the line. This form is only applicable to injuries by accident occurring on or after July 1, 2007 pursuant to Title 42-15-60 (A) as amended.
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