The Official Web Site of the State of South Carolina

Claimant Forms

Form Description PDF Doc Fee
16 Agreement for Permanent Disability/ Disfigurement Compensation PDF Doc $50.00 if Claimant Represented
16A

Agreement for Permanent Disability/ Disfigurement Compensation (injuries after July 1, 2007)

 PDF Doc $50.00 if Claimant Represented
17 Receipt of Compensation PDF Doc No Fee
20 Statement of Earning of Injured Employee PDF Doc No Fee
24 Application for Lump Sum Award PDF Doc $50.00
27 Subpoena PDF Doc No Fee
30 Request for Commission Review (Appellate Panel Review) PDF Doc $150
32 Request to Waive Filing Fee PDF Doc No Fee
50 Employee's Notice of Claim or Hearing Request PDF Doc $50/ Hearing Request only
52 Employee's Notice of Claim or Hearing Request (Death Claim) PDF Doc $50.00/ Hearing Request only
58 Pre-Hearing Brief PDF Doc No Fee
59 Appellant's Informational Brief PDF Doc No Fee
65 Occupational Disease Waiver PDF Doc No Fee
S-2 Notice of Third-Party Action (Employee) PDF Doc No Fee
  Single Commissioner Decision & Order Template   Doc No Fee
  Appellate Panel Decision & Order Template   Doc No Fee
  Certificate of Service   Doc No Fee