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Posted on behalf of Harbin & Burnett on Apr 30, 2018 in Workers' Compensation

What is a Form 50?

A form 50 is a document used by the South Carolina Workers' Compensation Commission. An individual, by himself or by and through an attorney, can use a Form 50 to open a worker's compensation claim and/or request a hearing in the matter. The Form is relatively easy to fill out and contains the information needed by the Commission to open a claim.  A completed form will contain the injured worker's name, social security number, address, and phone number.  It will contain the employer's name, address, and insurance carrier.

The body of the form will contain information about when, where and how the worker was injured and what body parts are affected. The worker will indicate how the employer was notifed and whether medical treatment is needed.  If the worker has begun treatment, the treating doctors will be listed.  If a hearing is needed, it can be requested on the form as can mediation.  Some cases require mediation while others allow mediation if both parties agree.

Finally there is a place to show who the document was served upon and by what method.

If you need a Form 50 or would just like to see one, click here: SCWCC Forms.


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