South Carolina Workers’ Compensation Forms
The South Carolina Workers’ Compensation Commission offers all of its necessary forms in Word and PDF fillable format on their website at https://www.wcc.sc.gov. For the convenience of our clients, we have provided those exact same workers’ compensation forms here on our website. You can download and fill them out or print and complete them manually.
If you have questions or need assistance with any of these forms, please contact the Steinberg Law Firm at 843-720-2800. We highly recommend that you do not attempt to complete these forms without the guidance of an experienced workers’ compensation attorney.
| Form # | Name | Download | Filing Fee |
| Form 5 | Corporate Officer Notice to Reject | No Fee | |
| Form 6 | Application to Create a Self-Insurance Fund | $250.00 | |
| Form 6A | Application for Membership in a Self-Insured Fund | $25.00 | |
| Form 7 | Application to Individually Self-Insure | $250.00 plus $100.00 for each subsidiary | |
| Form 7A | Corporate Guaranty | No fee | |
| Form 8 | SC Workers’ Com. Comm. Bond Required of Employer Carrying His Own Risk | No fee | |
| Form 8B | Irrevocable Letter of Credit | No fee | |
| Form 10 | South Carolina Self-Insurance Tax Form (for calculations, Java scripting must be enabled in Adobe Reader) | No fee | |
| Form 11 | Fund Quarterly Financial Report | No fee | |
| Form 12A | First Report of Injury | No fee | |
| Form 12M | Annual Minor Medical Report | No fee | |
| Form 14A | Health Insurance Claim Form | No fee | |
| Form 14B | Physician’s Statement | No fee | |
| Form 15 | Temporary Compensation Report | $25.00 for Section III only | |
| Form 15S | Supplemental Report of Varying Temporary Partial Payments | No fee | |
| Form 16 | Agreement for Permanent Disability/ Disfigurement Compensation | $25.00 if Claimant is represented | |
| Form 16A | Agreement for Permanent Disability/ Disfigurement Compensation For injuries occurring after July 1, 2007. | $25.00 if Claimant is represented | |
| Form 17 | Receipt of Compensation | No fee | |
| Form 18 | Periodic Report | No fee | |
| Form 19 | Status Report and Compensation Receipt | No fee | |
| Form 20 | Statement of Earning of Injured Employee | No fee | |
| Form 21 | Employer’s Request for Hearing | $25.00 | |
| Form 22 | Claimant’s Answer to Request for A Hearing | No fee | |
| Form 24 | Application for Lump Sum Award | $25.00 | |
| Form 27 | Subpoena | No fee | |
| Form 30 | Request for Commission Review | $150.00 | |
| Form 32 | Request to Waive Appeal Filing Fee | No fee | |
| Form 33 | Hearing Postponed | No fee | |
| Form 38 | Employer’s Withdrawal of Election to Adopt the South Carolina Workers’ Compensation Act | No fee | |
| Form 39 | Coverage Coding Sheet | No fee | |
| Form 50 | Employee’s Notice of Claim and or Request for Hearing | $25.00 for Request for Hearing only | |
| Form 51 | Employer’s Answer to Request for Hearing | No fee | |
| Form 52 | Employee’s Notice of Claim and/or Request for Hearing | $25.00 for Request for Hearing only | |
| Form 53 | Employer’s Answer to Request for Hearing, Death Case | No fee | |
| Form 54 | Employer’s Notice of Claim and/or Request for Hearing | $25.00 | |
| Form 55 | Second Injury Fund’s Answer to Employee’s Request for Hearing | No fee | |
| Form 58 | Pre-Hearing Brief | No fee | |
| Form 59 | Appellant’s Informal Brief | No fee | |
| Form 61 | Attorney Fee Petition | No fee | |
| 61 Order | Attorney Fee Petition | No fee | |
| 61A | Attorney Fee Petition Supplemental Information | No fee | |
| Form 65 | Occupational Disease Waiver | No Fee | |
| Form 70 (Effective July 2013) | Mediator Report | No fee | |
| Form S-1 | Notice of Third Party Action Employee Carrier | No fee | |
| Form S-2 | Notice of Third Party Action Employee | No fee | |
| Form S-3 | Entitlement to Right of Action | No fee | |
| Form S-4 | Court Certificate | No fee |
Practice Areas
Results
WE HAVE RECOVERED OVER $800 MILLION FOR CLIENTS IN THE LAST 10 YEARS, INCLUDING:
Leaders in the Legal Industry
Steinberg attorneys have been awarded numerous distinctions, such as Super Lawyers, Best Lawyers in America by U.S. News & World Report, Gedney M. Howe, Jr. Award for Outstanding Public Service, the SC Leadership in Law award, and has been voted Best Workers’ Comp Firm in SC, among other distinctions.
What Our Clients Say
They have amazing lawyers!
They have worked on an impossible situation and exceeded all expectations in the resulting settlements. I would recommend the Steinberg Law Firm to anyone and everyone!
- Susan
My experience was excellent
From the first consultation to the end of my case I was kept updated step by step. My attorney worked hard for me and got me more than what I expected.
- Vanessa
I never felt like I was alone
My lawyer and his Paralegal were right with me the entire case. I never felt like I was alone. At every turn they were in my corner. Someone recommended me to Steinberg law firm and I gladly would do the same for someone else.
- Mike
I couldn't have asked for better
The people from the Steinberg group are top-notch. They handled my case extremely well, I couldn’t have asked for a better performance. Thank you all so much for all you did for me.
- Brian
I am grateful for them!
At my worst, they honestly and carefully protected and defended my family on multiple levels. I’m a client for life and the integrity of this law firm is unmatched. Thank You Steinberg Law Family!!!
- Brandy
The people are thoughtful and professional
Questions and concerns always get answered and concerns are taken care of. Thank you all at Steinburg for a good experience and for showing me that you care about your clients.
- Joan
The best law firm
This the best law firm anyone could ever deal with. Mr. Pearlman will work hard to get everything that is owed to you. It was a pleasure to have been represented by this firm.
- Rena
A wonderful experience
Had a wonderful experience with Mr. Pearlman and his team. Thank you very much for your diligence and expertise.
- Meagan
I highly recommend them
They work as a team providing the best referrals and assistance to accomplish what my family and I needed. I highly recommend them because you won’t be disappointed.