The Official Web Site of the State of South Carolina

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Advisory Notice: Revised protocols for remote appearances by parties and/ or witnesses and virtual hearings. The full notice may be accessed here.

Advisory Notice: Commission action on proposed regulation changes R.67-206, R.67-411, AND R.67-1507. The full notice may be accessed here.

Advisory Notice: The Administrative Procedures Act will be in effect beginning 11/1/2025. The full notice may be accessed here.

Advisory Notice: On October 1, 2025 the Commission will implement metal detection & screening at the Commission’s Offices. The full notice may be accessed here.

South Carolina Workers' Compensation Commission

Self-Insurance Forms

The South Carolina Workers’ Compensation Commission offers the following forms applicable to self-insurance procedures.

If you require assistance, please contact the Self-Insurance Division

Self-Insurance Division
Telephone: 803-737-5412
self-insurance@wcc.sc.gov

6	Application to Create a Self-Insurance Fund	PDF	Doc	$250.00
6A	Application for Membership in a Self-Insured Fund	PDF		$25.00
7	Application to Individually Self-Insure	PDF	Doc	$250.00 plus $100.00 for each subsidiary
7A	Corporate Guaranty	PDF	Doc	No fee
8	SC Workers’ Compensation Commission Bond Required of Employer Carrying His Own Risk	PDF	Doc	No fee
8B	Irrevocable Letter of Credit	PDF	Doc	No fee
10	South Carolina Self-Insurance Tax Form	PDF		No fee
11	Fund Quarterly Financial Report	PDF	Doc	No fee