This is one of the official workers' compensation forms for the the state of South Carolina
South Carolina Statement of Earnings of Injured Employee
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FAQ
Form 105 is an Agreement to Extend the 180 Day Payment Without Prejudice Period (PWOP). Workers' Compensation insurers may send this form to you if you are injured and have not gotten an attorney.
Notify your employer of your work-related injury orally and in writing as soon as possible. See a doctor. Describe your work-related injury or illness to the doctor. With 30 days, report the injury to your employer in writing. Follow doctor's orders.
Gross wages include salaries, commissions, bonuses, vacation, holiday pay, sick pay, overtime base wages, the market value of gifts, all substitutes for money earned or paid during the policy period including meals and lodging in lieu of wages, automobile allowances, and some pension play payments explained below.
Workers' Comp Payroll DefinitionWages or salaries including retroactive wages or salaries. Total cash received by employees for commissions and draws against commissions. Bonuses including stock bonus plans. Extra pay for overtime work-see next section for exceptions.
Exclusions in payroll for Workers Compensation insurance: The value of special rewards for individual invention or discovery. Dismissal or severance payments, except for time worked or accrued vacation. Payments for active military duty. Employee discounts on goods purchased from employer.
If an injury or alleged injury causes the employee to be absent from work for more than one day, or the employee's medical expenses are greater than $2000.00, the employer or carrier must file with the Industrial Commission a Form 19 Employer's Report of Employee's Injury to the Industrial Commission within five days
A Form 18 establishes a legal claim of injury on your behalf if filed within two years of the date of injury or occupational. disease, and gives the required written notice to the employer if a copy is submitted to the employer within 30 days of the. injury.
Workers Compensation Calculator Most often, benefits are calculated and paid based on the average weekly wage. This is calculated by multiplying the employee's daily wage by the number of days worked in a full year. That number is then divided by 52 weeks to get the average weekly wage.
The North Carolina Workers' Compensation Act (NCWCA) states all businesses with three or more employees must carry workers' compensation insurance. This includes businesses operating as: Corporations. Sole proprietorships.