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