S.C. Code Ann. Regs. 67-1809
A Form 70 shall be filed by the mediator with the Judicial Department at the conclusion of the mediation. A Form 70 shall not become a part of the Commission’s file, and will solely be used for tracking purposes. The Commission shall not process a Form 19 or further request for hearing until a Form 70 has been filed with the Commission.
FORMS
| Form # | Title of Form |
| 5 | Corporate Officer Notice to Reject |
| 6 | Application to Create a Self-Insurance Fund |
| 6A | Application for Membership in a Self-Insured Fund |
| 7 | Application to Individually Self-Insure |
| 7A | Corporate Guaranty |
| 8 | Bond Required of Employer Carrying His Own Risk |
| 8B | Irrevocable Letter of Credit |
| 10 | South Carolina Self-Insurance Tax Form |
| 11 | Fund Quarterly Financial Report |
| 12A | First Report of Injury |
| 12M | Annual Minor Medical Report |
| 14A | Health Insurance Claim Form |
| 14B | Physician’s Statement |
| 15 | Temporary Compensation Report |
| 15S | Supplemental Report of Varying Temporary Partial Payments |
| 16 | Agreement for Permanent Disability/Disfigurement Compensation |
| 16A | Agreement for Permanent Disability/Disfigurement Compensation |
| 17 | Receipt of Compensation |
| 18 | Periodic Report |
| 19 | Status Report and Compensation Receipt |
| 20 | Statement of Earnings of Injured Employee |
| 21 | Employer’s Request for Hearing |
| 24 | Application for Lump Sum Award |
| 27 | Subpoena |
| 30 | Request for Commission Review |
| 32 | Request to Waive Filing Fee |
| 33 | Hearing Postponed |
| 38 | Employer’s Withdrawal of Election to Adopt the South Carolina Workers’ Compensation Act |
| 39 | Coverage Coding Sheet |
| 50 | Employee’s Notice of Claim and/or Request for Hearing |
| 51 | Employer’s Answer to Request for Hearing |
| 52 | Claimant’s Notice of Claim and/or Request for Hearing, Death Case |
| 53 | Employer’s Answer to Request for Hearing, Death Case |
| 54 | Employer’s Notice of Claim and/or Request for Hearing |
| 55 | Second Injury Fund’s Answer to Employee’s Request for Hearing |
| 58 | Pre-Hearing Brief |
| 59 | Appellant’s Informal Brief |
| 61 | Attorney Fee Petition |
| 61 Order | Attorney Fee Petition |
| 61A | Attorney Fee Petition Supplemental Information |
| 65 | Occupational Disease Waiver |
| 70 | Mediator Report |
| S-1 | Notice of Third Party Action, Employee Carrier |
| S-2 | Notice of Third Party Action, Employee |
| S-3 | Entitlement to Right of Action |
| S-4 | Court Certificate |
| Miscellaneous Notices | |
| Physician’s Statement | |
| Advisory Guidelines for the Use of Translators/Interpreters | |
| Uninsured Employer’s Fund | |
| Settlement Conferences | |
| Electronic Service | |
| Cases Set for Informal Conference | |
| Relief of Counsel | |
| Mediations Submission of Form 70 | |
| Commission Updates Secure Email System | |
| Submission of Consent Orders and Settlement Agreements and Releases | |
| Form 19 | |
| Clarification of Commission Records Requests Procedures | |
| Amendment to S.C. Code Ann. Regs. 67-610 | |
| Amendment to the Commission’s Court Reporter Policy | |
| Amendment to Forms 21, 30, 50, 51, 52, 53, and 58 | |
| Net Present Value Table |
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HISTORY: Added by State Register Volume 37, Issue No. 6, eff June 28, 2013. Amended by SCSR 42-2 Doc. No. 4735, eff February 23, 2018.