The Official Web Site of the State of South Carolina

Carrier Forms

 

Form # Description PDF DOC Filing Fee
12A

First Report of Injury

 PDF Doc No fee
12M Annual Minor Medical Report PDF Doc No fee
14A Health Insurance Claim Form PDF Doc Format
Not Available		 No fee
15 Temporary Compensation Report PDF Doc $50.00 for Section III only
15S Supplemental Report of Varying Temporary Partial Payments PDF Doc No fee
16 Agreement for Permanent Disability / Disfigurement Compensation PDF Doc $50.00 if Claimant is represented
16A

Agreement for Permanent Disability / Disfigurement Compensation

Please complete this form for injuries occurring after July 1, 2007.

 PDF Doc

$50.00 if Claimant is represented
17

Receipt of Compensation

 PDF Doc No fee
18 Periodic Report PDF Doc No fee
19 Status Report and Compensation Receipt PDF Doc No fee
20 Statement of Earning of Injured Employee PDF Doc No fee
S-1

Notice of Third Party Action Employee Carrier

 PDF Doc No fee
S-3

Entitlement to Right of Action

 PDF Doc No fee
S-4

Court Certificate

 PDF Doc No fee