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The Official Web Site of the State of South Carolina

Reports and Forms

Reports

Reports should be accessed via the web portal. If you have questions regarding your login or access to the portal please email clientsupport@saf.sc.gov.

Forms

The WCC Form 12-A is completed by your Medical Management Vendor at the time you make the initial call to report an injury. In order to report an injury, please contact your Medical Management Vendor. They will take all of the pertinent information, direct the injured worker to a doctor if needed and complete and send the 12-A to the State Accident Fund. We recommend you have the following items available when you contact the Medical Management Vendor:

  • the employee's personnel records
  • the employee's payroll records
  • any medical bills, reports, or statements containing information on the nature of the accident and/or the extent of the injury.

The WCC Form 20 verifies the claimant's earnings (Average Weekly Wage) during the last twelve months prior to the accident. Compensation is based on this amount. When preparing the WCC Form 20, follow the instructions provided on the form. Quarterly wage information needed on the WCC Form 20 is in the same format as that already reported by your organization to the South Carolina Employment Security Commission. A copy of their form (SC ESC Employer Contribution Report) should be available in your payroll or accounting department. Please contact your adjuster if assistance is needed completing a Form 20.

Below are common forms related to the claims process.

WCC 12A Form (PDF)

WCC 20 Form (PDF)

Election Form

For state agencies, please reference the latest version of the Coordinating Sick and Annual Leave with Workers' Compensation Payment as published by the South Carolina Department of Administration.

2019-01-31-Coordinating Sick and Annual Leave with Workers' Compensation Payments (PDF)

2019-01-31-Coordinating Sick and Annual Leave with Workers' Compensation for 2019 (PDF)