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Carrier Claim # NOTICE OF REPRESENTATION OR WITHDRAWAL OF REPRESENTATION GENERAL CLAIM AND REPRESENTATIVE IDENTIFICATION INFORMATION Section I. Injured Employee Information 1a. Last Name 1b. First Name 2. Date of Birth (mm/dd/yyyy) 3. Social Security Number 1c. Middle Name 4a. Phone Area Code 4b. Phone Number 4c. Phone Extension 6b. City 6a. Street Address 6c. State 1d. Name Suffix 5. Date of Injury (mm/dd/yyyy) 6d. Zip Code Section II. Beneficiar.

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Related content

Forms - South Carolina Workers' Compensation...
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For repetitive injuries, the paperwork must be filed within two years from when you knew (or should have known) that the injury could entitle you to benefits, or seven years from the last occupational exposure. After being notified of your injury, your employer must report it to their insurer within 10 days.

The report [PDF] shows a downward trend in employers' overall workers' comp costs. The costs per $100 in covered wages decreased in every state between 2016 and 2020....The highest workers' comp rates by state jurisdiction are: Wyoming: $1.78. Alaska: $1.74. Hawaii: $1.69. Montana: $1.64. South Carolina: $1.55. Idaho: $1.47.

The law requires a seven-day waiting period before benefits can be paid. If you are out of work for more than seven days, payments will come from your employer's insurance representative. If you are out of work for more than 14 days, you will receive compensation even for the first seven days.

DWC-1 Workers Compensation Claim Form. This is the form you will complete and send to EMPLOYERS to initiate the claim process for your employee. This form must be completed and provided to EMPLOYERS within one working day from you becoming aware of a work-related injury or occupational disease.

What is the Time Frame for Workers' Compensation in South Carolina? An injured worker may receive workers' compensation for up to 500 weeks, with payments lasting a lifetime in permanent and total disability cases involving any degree of paralysis or a serious and permanent brain injury.

If you are entitled to temporary total compensation you will receive 66 2/3% of your average weekly wages based on the four quarters prior to your injury but no more than the maximum average weekly wage determined yearly by the South Carolina Department of Employment and Workforce.

Working While Receiving Workers' Compensation In South Carolina, you cannot return to light-duty work without authorization from your physician. Injured employees that return to work may continue to receive workers' compensation benefits.

If you are entitled to temporary total compensation you will receive 66 2/3% of your average weekly wages based on the four quarters prior to your injury but no more than the maximum average weekly wage determined yearly by the South Carolina Department of Employment and Workforce.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232