Understanding the Most Commonly Used South Carolina Workers’ Compensation Forms

by | Aug 17, 2015 | Firm News, Workers Compensation

Sometimes in a workers’ compensation case it can seem like everyone is speaking a special language that only they know. The South Carolina workers’ compensation system is form driven, meaning that most everything that is filed with the South Carolina Workers’ Compensation Commission is done by way of a special form. It can be confusing at first, but here are some common forms and what they are used for. I have put them in the order that they will probably be filed instead of putting them in number order.

Form 20  Statement of Earning of Injured Employee

This is the form your employer uses to tell the South Carolina Workers’ Compensation Commission how much you make and how much they need to pay you every week if you are written out of work by a doctor. It is important that this form is correct or it could cost you weekly benefits and could even make your claim worth less at the end.

Form 50  Employee’s Notice of Claim and/or Request for a Hearing

An employee files this form to let the Commission know they are alleging a workers’ compensation injury/claim. They are also filed when the  employee is requesting a hearing for any number of reasons. An employee would file a form 50 with the Commission for various reasons, including but not limited to: if the Employer is not providing medical care, is not paying for lost time from work, or to determine the amount of payment for permanent disability. This form is used much like a Summons and Complaint in civil cases.

Form 51  Employer’s Answer to Request for Hearing

This is the form the employer files in response to the employee’s Form 50. It is much like the Answer in a civil case.

Form 21  Employer’s Request for Hearing

If the employer would like a hearing for any number of reasons, such as: to stop the employee’s weekly pay or to determine the employees permanent disability at the end of the case, the employer can ask for a hearing by filing a Form 21.

Form 17  Receipt of Compensation

This form is offered to the employee when the employer feels the employee can go back to work, has been offered a job within the employee’s restrictions or has been offered a job that the employee has refused.  Be very careful when signing this form.  Sometimes it is appropriate to sign the form, but the employer can stop your weekly checks if this form is signed. It is always good to get legal advice before signing this form, which can have serious consequences.

Form 14B  Physician’s Statement

When the employee has reached maximum medical improvement as determined by their treating physician, the physician fills out a Form 14B.  This will list the date of maximum medical improvement and list the percentage of any permanent impairment and any recommended future medical care.

Form 19  Status Report and Compensation Receipt

An employer files this form with the Commission to close your case.  Many times the employer will file one of these forms with the Commission if they are denying your case.

Form 16A  Agreement for Permanent Disability/Disfigurement Compensation

There are two different ways to settle a workers’ compensation case: via a clincher or via a Form 16A. In a clincher, the employer pay the employee more money to end the case forever. In a Form 16A the case is settled, but the employee has a right to reopen the case within a year for a change of condition for the worse. If the treating physician has recommended any future medical care on the Form 14B, it should be listed on the Form 16A and then the employer will be responsible for providing that care into the future.

The South Carolina Workers’ Compensation Commission has many other forms, but these listed above are the most common that employees would see.  We pride ourselves in explaining the workers’ compensation process in an understandable way and in empowering our clients so that they feel in control of their workers’ compensation claim. We know that navigating a work- related injury can be confusing. We are here to help.

Every case is different. It is best to have an experienced lawyer here all the facts of your case, so that they can ensure that you are receiving all the benefits and compensation you are entitled to under the South Carolina Workers’ Compensation Act. If you have questions about the form you have received or your workers’ compensation claim, please contact Venus Poe today at 864-963-0310 or click here to fill out an online case evaluation form. There is no obligation or charge to see if we can help you with your workers’ compensation claim.

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