reglab/statecodes huggingface dataset:
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 7 - REVIEW AND HEARING › Section 67-710 - Settlement of a Claim Pending Review

Current through Register Vol. 48, No. 6, June 28, 2024
A. If the parties settle a claim after filing
			 a Form 30, the appellant shall immediately notify the Commission's Judicial
			 Department in writing.
B. The
			 Judicial Department will remove the case from the review hearing docket or
			 notify the Commission an order is not required.
C. When the terms of the settlement, as in
			 Article 8, are filed with the Commission, an administrative order will be
			 issued dismissing the appeal upon consent of the parties.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 7 - REVIEW AND HEARING › Section 67-711 - Transcripts

Current through Register Vol. 48, No. 6, June 28, 2024
A. Oral argument
			 presented to the Commission is recorded.
B. A transcript may be requested by notifying
			 the Commission's Judicial Department. The terms and costs as in R.67-615
			 shall apply.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 7 - REVIEW AND HEARING › Section 67-712 - Requesting Higher Court Review

Current through Register Vol. 48, No. 6, June 28, 2024
A. The appellant shall notify the Judicial
			 Department of any and all subsequent appeals.
B. The prevailing party shall provide the
			 Judicial Department with a copy of any orders issued by the courts on appeal.
			 The prevailing party shall also notify the Commission in writing when a final
			 order issued by the courts on appeal remits jurisdiction to the
			 Commission.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 8 - SETTLEMENTS, PROCEDURES › Section 67-801 - Settlement of the Claim, General

Current through Register Vol. 48, No. 6, June 28, 2024
A. After the claimant reaches maximum medical
			 improvement the parties may agree to settle the claim by signing a Form 16 or
			 Form 16A, Agreement for Permanent Disability/Disfigurement Compensation, or by
			 signing an Agreement and Final Release (clincher).
B. If each party is represented by an
			 attorney, an appearance before a Commissioner is not required for approval of a
			 settlement unless either party requests an informal conference, or the
			 Commissioner schedules a hearing.
C. If the claimant is not represented by an
			 attorney, the parties must appear before the Commissioner assigned to the claim
			 at an informal conference for approval of the settlement. At the informal
			 conference, the Commissioner will review the proposed settlement and may
			 approve it if the Commissioner finds the settlement fairly made and in
			 accordance with the provisions of the Act.
D. A Form 16 or Form 16A retains the
			 claimant's right to request a hearing according to R.67-207
			 for additional benefits not later than one year from the date of the last
			 compensation payment. By signing the Form 16 or Form 16A, the employer's
			 representative does not agree it will make any additional payments in the
			 future unless the form specifically provides otherwise.
E. An Agreement and Final Release (clincher)
			 relieves the employer and its representative from any further responsibility
			 for payment of compensation or medical expenses, unless the Agreement and Final
			 Release specifically provides otherwise. When the claimant signs the Agreement
			 and Final Release and it is approved, the claimant does not have the right to
			 ask for additional payments in the future even if the claimant's medical
			 condition worsens, unless otherwise specifically provided in the
			 document.
F. An official copy of
			 the settlement is approved and certified by the Commission as
			 binding.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 8 - SETTLEMENTS, PROCEDURES › Section 67-802 - Settlement, Form 16, Form 16A

Current through Register Vol. 48, No. 6, June 28, 2024
A. If the parties agree to the terms of a
			 Form 16 or Form 16A, the employer's representative shall complete a Form 16 or
			 Form 16A by recording the claimant's compensation rate; the percent of
			 disability agreed upon disfigurement, if any; and the number of weeks of
			 compensation the claimant will receive. The form may be approved as follows:
(1) If the claimant is not represented by an
			 attorney, the Form 16 or Form 16A must be approved at an informal conference.
(a) The employer's representative must
			 request an informal conference by writing the Judicial Department requesting
			 that an informal conference be scheduled, and filing an updated Form 18 or the
			 EDI equivalent Sub Annual (SA) Periodic Report showing the status of payment of
			 temporary compensation, if any, and medical expenses with the Commission's
			 Judicial Department. For claims arising after July 1, 2007, a Form 14B is also
			 required. The Commission shall accept medical records containing the
			 substantial equivalent of the information contained in the Form 14B only when
			 the party certifies and documents that it has made a good faith effort to
			 obtain a completed Form 14B, and the hospital or physician has unreasonably
			 refused to complete a Form 14B. The claimant may request an informal conference
			 by writing to the Judicial Department.
(b) If the parties at the informal conference
			 reach an agreement which the Commissioner approves, or the claims mediator
			 recommends, the parties shall sign the agreement. (A Commissioner must approve
			 a claims mediator's recommendation before the settlement is recorded as
			 binding.)
(c) If the parties do not
			 reach an agreement of which the Commissioner approves, the Commission shall set
			 the matter for hearing pursuant to R.67-804I.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 8 - SETTLEMENTS, PROCEDURES › Section 67-803 - Settlement by Agreement and Final Release

Current through Register Vol. 48, No. 6, June 28, 2024
A. If the parties agree to the terms of a
			 settlement by entering into an Agreement and Final Release, the document shall
			 include the following:
(1) The caption of the
			 claim;
(2) A statement of the facts
			 at issue;
(3) The date and nature
			 of the alleged injury coinciding with the date and nature of each injury on the
			 Form 12A, Form 50, or Form 52;
(4)
			 The amount of the settlement and terms of payment; and
(5) The signature of the claimant, his or her
			 attorney, if any, and the attorney for the employer's representative.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 8 - SETTLEMENTS, PROCEDURES › Section 67-804 - Informal Conference

Current through Register Vol. 48, No. 6, June 28, 2024
A.
			 Appearances at Informal Conferences.
(1) A
			 claims mediator may appear on behalf of a Commissioner at an informal
			 conference when the purpose of the informal conference is to:
(a) review a proposed Form 16 or Form 16A
			 settlement when the total amount of medical benefits paid is below the
			 threshold amount established by the Commission; or
(b) certify a Form 17.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 8 - SETTLEMENTS, PROCEDURES › Section 67-805 - Third Party Settlements

Current through Register Vol. 48, No. 6, June 28, 2024
A. The
			 distribution of third party settlement proceeds must be filed with the
			 Commission unless otherwise directed by a court of competent
			 jurisdiction.
B. File the
			 settlement documents with the Claims Department.
C. If the parties agree, third party
			 settlements less than two thousand five hundred dollars do not need to be filed
			 with the Commission.
D. If the
			 claimant is not represented by an attorney, the third party settlement must be
			 approved at an informal conference according to R.67-803B(1).
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 9 - PROCEDURE FOR CLAIM INVOLVING A FATALITY › Section 67-901 - Notification that a Fatality has Occurred, Required

Current through Register Vol. 48, No. 6, June 28, 2024
A. The employer's representative must state
			 on the Form 12A a fatality has occurred.
B. If after a Form 12A is filed the claimant
			 dies, the employer's representative must notify the Commission's Claims
			 Department by letter stating the date of death and whether the fatality is
			 believed to be related to the earlier injury.
C. The Commission will notify the Second
			 Injury Fund of reported fatalities.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 9 - PROCEDURE FOR CLAIM INVOLVING A FATALITY › Section 67-902 - Discovery of Beneficiaries

Current through Register Vol. 48, No. 6, June 28, 2024
A.
			 The employer's representative must make a good faith effort to discover the
			 decedent's beneficiaries.
B. The
			 employer's representative shall attach to the Form 12A a list of the names,
			 addresses, and ages of all known beneficiaries.
C. If the employer's representative discovers
			 additional beneficiaries after the 12A is filed it shall immediately notify the
			 Commission's Claims Department in writing of the beneficiaries names,
			 addresses, and ages, if known.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 9 - PROCEDURE FOR CLAIM INVOLVING A FATALITY › Section 67-903 - Fatality, Statement on Liability Required

Current through Register Vol. 48, No. 6, June 28, 2024
A. When the Commission is notified a fatality
			 has occurred, the Commission's Claims Department requests a statement from the
			 employer's representative on liability.
(1)
			 The employer's representative shall file a reply in writing with the Claims
			 Department at least thirty days from the date of the Commission's
			 inquiry.
(2) The letter must state
			 the employer's position on liability and that all known beneficiaries have been
			 reported.
(3) The Claims Department
			 will send a copy of the letter to all reported beneficiaries and request from
			 the known beneficiaries the names and addresses of any other
			 beneficiaries.
(4) Failure of the
			 employer's representative to respond may result in a fine imposed against the
			 employer's representative. Failure to reply is deemed a denial of
			 liability.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 9 - PROCEDURE FOR CLAIM INVOLVING A FATALITY › Section 67-904 - Employer Accepts Liability, Procedure

Current through Register Vol. 48, No. 6, June 28, 2024
A. If the employer's representative accepts
			 liability for a claim involving a fatality the Commission will automatically
			 set a hearing to determine beneficiaries.
(1)
			 The parties are notified of the date, time, and place of the hearing.
(2) A Guardian ad Litem must be appointed
			 according to R.67-216.
(3) The
			 amount of compensation due each beneficiary will be determined at the
			 hearing.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 9 - PROCEDURE FOR CLAIM INVOLVING A FATALITY › Section 67-905 - Employer Denies Liability, Procedure

Current through Register Vol. 48, No. 6, June 28, 2024
A. If the employer's representative denies
			 liability of a claim involving a fatality, the claimant must request a hearing
			 by filing a Form 52 according to R.67-207.
B. A Guardian ad Litem must be appointed
			 according to R.67-216.
C. If a
			 hearing is not requested by a claimant within sixty days from the date the
			 notice in R.67-903
			 is mailed to the known beneficiaries, the employer's representative may file a
			 Form 19 with the Commission's Claims Department.
D. The file may be reopened by filing a Form
			 52 according to R.67-207.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 10 - OCCUPATIONAL DISEASE, PROCEDURE, AND WAIVER OF CLAIM › Section 67-1001 - Parties, Generally

Current through Register Vol. 48, No. 6, June 28, 2024
A. The
			 proper parties in a claim involving an occupational disease are often a matter
			 in dispute.
B. The claimant may
			 request a report from the Commission of the insurers of an employer or
			 employers at or during the period of alleged exposure. The period of alleged
			 exposure must be provided for each employer.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 10 - OCCUPATIONAL DISEASE, PROCEDURE, AND WAIVER OF CLAIM › Section 67-1002 - Occupational Disease, Waiver of Claim

Current through Register Vol. 48, No. 6, June 28, 2024
A. A person affected by occupational disease
			 who desires to continue in the same employment or to obtain new employment to
			 which such disease is a hazard, may waive his or her right to further benefits
			 for any incapacity or disability caused by an aggravation of the occupational
			 disease in the same or new employment according to the following
			 sections.
B. File a Form 65, Waiver
			 of Claim Involving an Occupational Disease, and physician's statement with the
			 Commission's Judicial Department at least ten days after signing the Form.
(1) The physician's statement must state the
			 physician has examined the applicant, the nature, extent, and probable duration
			 of the disease and an opinion as to whether or not the employee runs the risk
			 of becoming partially or totally incapacitated due to the employment
			 involved.
(2) The Judicial
			 Department will notify the applicant, the employer, and the employer's
			 representative of approval or disapproval of the form.
(3) The Commission's determination shall be
			 deemed effective the date of filing the Form 65 with the Judicial
			 Department.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 11 - SCHEDULED LOSSES › Section 67-1101 - Total or Partial Loss or Loss of Use of a Member, Organ, or Part of the Body

Current through Register Vol. 48, No. 6, June 28, 2024
A.
			 This regulation does not include injury to the many bodily systems, organs,
			 members, and anatomical parts for which compensation is payable due to
			 disability or serious disfigurement under Section
			 42-9-10
			 and Section
			 42-9-20.
B. This schedule of organs, members, and
			 bodily parts lists prominent parts of the anatomy subject to occupational
			 injury and is not complete. The value of an organ, member, or bodily part not
			 included may be determined in accordance with the American Medical
			 Association's "Guide to the Evaluation of Permanent Impairment", or any other
			 accepted medical treatise or authority. Compensation shall be payable shall be
			 payable for total loss, permanent partial loss, or loss of use of a member,
			 organ, or part of the body when compensation is not otherwise
			 payable.
C. For total loss, partial
			 loss, or loss of use of an organ, member, or body part listed in this
			 regulation, disability shall be deemed to continue for the minimum period
			 specified, if applicable. In cases involving impairment and disability in
			 excess of the minimum period specified for partial loss of or loss of use of an
			 organ, member, or bodily part, compensation shall be payable in such proportion
			 as disability bears to the maximum number of weeks provided in this regulation.
			 The maximum period of compensation for a combination of injuries is the
			 legislative criterion of five hundred weeks.
Partial Loss or
Organ, Member or Body Part
Total Loss
Loss of Use
Breast
75
10-75
Breasts
250
25-250
Coccyx
10
1-10
Gall Bladder
75
10-75
Kidney
400
25-250
Lung
400
25-250
Pancreas
500
10-250
Rib
10
1 1/2 -10
(Maximum award of 200 weeks for total loss of
							 4
ribs)
Scrotum and Testicles
350
30-300
Spleen
25
2 1/2 -25
Testicle
75
10-75
Testicles
250
25-250
Tongue
500
50-500
Tooth
2
1/2 -2
Biliary Tract
75-400
Bladder
25-250
Brain
25-250
Bronchi or Bronchus
25-400
Esophagus
25-400
Cervix
10-100
Clavicle
10-100
Colon
25-250
Diaphragm
25-250
Duodenum
10-250
Fallopian Tubes
10-100
Heart
25-250
Intestine, Small
10-400
Larynx
25-400
Liver
25-250
Mandible
10-100
Ovaries
10-100
Palate
25-250
Penis
25-250
Prostate
10-100
Rectum
10-250
Scapula
10-200
Skin
5-300
Spermatic Cord
10-100
Sternum
10-100
Stomach
25-250
Thyroid Gland
10-100
Ureter
10-100
Urethra
10-100
Vagina
25-250
Vulva
25-250
Nasal Pasage
10-75
Olfactory Nerve
10-75
Sinus
5-30
Zygomatic Arch or Facial Nerve
(In accordance with the AMA "Guides")
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 11 - SCHEDULED LOSSES › Section 67-1102 - Loss of Hearing

Current through Register Vol. 48, No. 6, June 28, 2024
A. The
			 method for determining hearing impairment is based on the American Academy of
			 Otolaryngology "Guide for Evaluation of Hearing Handicap", copyright 1979,
			 which is based upon the American Medical Association's "Guides to the
			 Evaluation of Permanent Impairment", copyright 1977.
B. The calculation of a hearing handicap is
			 derived from the pure tone audiogram, obtained with an audiometer calibrated to
			 ANSI S3.6-1969 standards and as follows.
(1)
			 The average of the hearing threshold levels at 500 Hz, 1000Hz, 2000Hz, and
			 3000Hz are calculated for each ear.
(2) The percent impairment for each ear is
			 calculated by multiplying by 1.5% the amount that the above average hearing
			 threshold level exceeds 25dB (low fence) up to a maximum of 100%, which is
			 reached at 92dB (high fence).
(3)
			 The hearing handicap, a binaural assessment, is calculated by multiplying the
			 smaller percentage (better ear) by five, adding this figure to the larger
			 percentage (poorer ear), and dividing the total by six.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 11 - SCHEDULED LOSSES › Section 67-1103 - Amputation of Finger or Toe

Current through Register Vol. 48, No. 6, June 28, 2024
A.
			 The amputation of any portion of the bone of the distal phalange of a finger or
			 toe to a point opposite the base of the nail is deemed the loss of one-fourth
			 of the finger or toe.
B. Amputation
			 below the base of the nail of the bone in the distal phalange is deemed loss of
			 one-half of a finger or toe.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 11 - SCHEDULED LOSSES › Section 67-1104 - Health Care for Injury Resulting in Hernia

Current through Register Vol. 48, No. 6, June 28, 2024
A. In a claim involving an injury resulting
			 in a hernia in which liability is denied and the claimant will be disabled
			 pending a hearing, the employer's representative may provide the claimant a
			 truss.
B. Health care provided in
			 section A above shall not be construed an admission of liability for payment of
			 temporary total compensation.
C.
			 The costs incurred in providing the claimant a truss may be charged as a
			 medical expense.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 11 - SCHEDULED LOSSES › Section 67-1105 - Loss of Vision

Current through Register Vol. 48, No. 6, June 28, 2024
A.
			 Loss of vision is based on reading without the use of corrective lenses. Eighty
			 percent loss of vision, or more, is considered one hundred percent industrial
			 blindness.
B. The following table,
			 derived from the Snellen Notation, is used to determine the percentage of
			 impairment to vision. The physician also may rely upon the American Medical
			 Association's "Guide to the Evaluation of Permanent Impairment" and any other
			 accepted medical authority or treatise in deriving an impairment
			 rating.
C. Loss in muscle function,
			 in conjunction with other factors, may warrant a greater percentage of loss of
			 vision.
Notation for Distance
Notation for Near
Percentage of Visual Efficiency
Percentage of Vision
20/20
14/14
100.0
0.0
20/25
14/17/5
95.7
4.3
20/30
14/21
91.5
8.5
20/35
14/24.5
87.5
12.5
20/40
14/28
83.6
16.4
20/45
14/31.5
80.0
20.0
20/50
14/35
76.5
23.5
20/60
14/42
69.9
30.1
20/70
14/49
64.0
36.0
20/80
14/56
58.5
41.5
20/90
14/63
53.4
46.6
20/100
14/70
48.9
51.1
20/120
14/84
40.9
59.1
20/140
14/96
34.2
66.8
20/160
14/112
28.6
71.4
20/180
14/126
23.9
76.1
20/200
14/140
20.0
80.0
(80% loss of vision is considered 100% industrial
							 blindness.)
20/220
14/154
16.7
83.3
20/240
14/168
14.0
86.0
20/260
14/182
11.7
88.3
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 12 - ATTORNEY PRACTICE AND FEES › Section 67-1201 - Appearances Before the Commission

Current through Register Vol. 48, No. 6, June 28, 2024
A. In all contested cases before a single
			 Commissioner and in all cases on Commission review, only attorneys licensed in
			 South Carolina may practice before the Commission except as provide in section
			 C below.
B. This regulation shall
			 not be construed to prevent a party from representing himself or herself as
			 otherwise allowed in this State.
C.
			 An attorney licensed in another state may represent a party by associating
			 himself or herself with an attorney licensed in South Carolina and receiving
			 permission as provided below.
(1) The
			 attorney may file a motion with the Commission's Judicial Department according
			 to R.67-215.
(2) The motion must be
			 limited to one case or proceeding and state the following:
(a) The state in which the attorney is
			 licensed to practice and the names of the Bars with which the attorney is in
			 good standing.
(b) That the
			 attorney will represent the party until a final determination of the case or
			 proceeding unless he or she is permitted to be relieved as counsel.
(c) The attorney agrees to be subject to the
			 orders, disciplinary rules, proceedings, and jurisdiction of the Commission and
			 the State of South Carolina as if the attorney were a member of the South
			 Carolina Bar.
(d) The signature of
			 an attorney licensed in South Carolina.
(e) A statement that the South Carolina
			 attorney is licensed, in good standing, is associated with the moving attorney
			 for the case or proceeding, is authorized to receive service, orders, and other
			 forms and documents, and that the South Carolina attorney will appear with the
			 moving attorney in Article 6 or Article 7 proceedings.
(3) Upon receipt of a motion, the Judicial
			 Department will assign the motion to a Commissioner assigned the claim. The
			 Commissioner may grant the motion without appearances by the attorneys or the
			 parties.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 12 - ATTORNEY PRACTICE AND FEES › Section 67-1202 - Attorney's Letter of Representation

Current through Register Vol. 48, No. 6, June 28, 2024
A. When an attorney is employed to represent
			 a party before the Commission, the attorney must notify the Commission by
			 writing the Commission's Judicial Department.
B. The attorney may notify the employer's
			 representative.
C. If an attorney
			 representing a claimant files a letter of representation with the Commission
			 and at the same times files a claim as provided in R.67-206, the letter
			 of representation must contain the information in R.67-206C(1) through
			 (12).
(1) The Commission will notify the
			 employer's representative a claim has been filed unless the letter states the
			 employer's representative has been given a copy of the letter.
(2) The attorney may state in the letter the
			 date the attorney was employed. If a date of employment is not included in a
			 letter of representation, the date of the letter of representation is deemed
			 the date of employment.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 12 - ATTORNEY PRACTICE AND FEES › Section 67-1203 - Withdrawing Representation

Current through Register Vol. 48, No. 6, June 28, 2024
A.
			 An attorney shall not withdraw as counsel without first obtaining an order from
			 the Commission.
B. An attorney may
			 withdraw as counsel on the showing of good cause. South Carolina Supreme Court
			 Disciplinary Rules and the Common Law of this State define good
			 cause.
C. An attorney may file with
			 the Commission's Judicial Department a Motion To Withdraw As Counsel, according
			 to R.67-215.
(1) A Form 61, Attorney Fee
			 Petition, may accompany the motion.
(2) The Commissioner assigned the claim, or
			 the Chair if a Commissioner has not been assigned the claim, will consider the
			 motion.
(3) The Commissioner may on
			 a showing of good cause, order the attorney relieved as counsel. If a Form 61
			 accompanies the motion, the Commissioner may issue an appropriate order
			 allowing a fee or ordering the attorney's fee considered upon the final
			 resolution of the claim.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 12 - ATTORNEY PRACTICE AND FEES › Section 67-1204 - Reporting Attorneys Fees for Approval

Current through Register Vol. 48, No. 6, June 28, 2024
A. An attorney shall report and obtain
			 approval of any fee for services rendered in a worker's compensation claim as
			 follows.
B. When the parties agree
			 to a fee based on an hourly rate and/or retainer the total amount of the fee
			 shall be reported on the Form 19, filed according to R.67-414.
C. When the parties agree to a contingent fee
			 contract, the attorney shall report the fee by filing the original and one copy
			 of a Form 61, Attorney Fee Petition, and an Order, along with a stamped,
			 self-addressed envelope with the Commission's Claims Department.
D. Upon receipt of a Form 61 and Order, the
			 Order may be signed and a copy returned to the attorney when the fee
			 calculation complies with R.67-1205.
E. The Commissioner may amend, sign, and
			 return a copy of the Order. If the attorney disagrees with the Amended Order,
			 the attorney may file a motion according to R.67-1205
			 with the Commission's Judicial Department. The motion may be heard according to
			 R.67-215, unless the motion
			 requests a hearing to present testimony or evidence.
F. If the Form 61 and Order do not comply
			 with R.67-1205,
			 the Commissioner reviewing the Form 61 and Order shall immediately schedule a
			 hearing to consider argument of counsel and testimony, if any.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 12 - ATTORNEY PRACTICE AND FEES › Section 67-1205 - Determining a Reasonable Fee

Current through Register Vol. 48, No. 6, June 28, 2024
A.
			 If the parties fix the fee by contract and base the fee on an hourly rate
			 and/or a retainer, the fee is deemed reasonable unless it conflicts with the
			 South Carolina Supreme Court Disciplinary Rule on determining reasonable
			 fees.
B. If the parties agree to a
			 contingent fee contract, the fee is deemed reasonable when the following
			 requirements are met and the requested fee does not conflict with the South
			 Carolina Supreme Court Disciplinary Rule on determining a reasonable fee.
(1) The attorney fully explains the fee
			 agreement to the client and informs the client of the total dollar amount of
			 the fee that will be deducted from the client's benefits; and
(2) The client agrees to the fee by signing a
			 completed Form 61; and
(3) The
			 attorney calculates the fee according to C below.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 12 - ATTORNEY PRACTICE AND FEES › Section 67-1206 - Costs

Current through Register Vol. 48, No. 6, June 28, 2024
A. In addition to
			 an attorney's contingent fee, an attorney may request approval of the actual
			 costs incurred in the prosecution of a claim by attaching a statement of costs
			 to the Form 61.
(1) The attorney waives the
			 request for reimbursement of costs when he or she does not attach the statement
			 to the Form 61.
(2) Costs include
			 witness fees, expenses associated with the deposition of a witness, service
			 costs, or expenses associated with the evaluation or treatment of the
			 client.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 12 - ATTORNEY PRACTICE AND FEES › Section 67-1207 - Collection of Attorney's Fee in a Lump Sum

Current through Register Vol. 48, No. 6, June 28, 2024
A. If the claimant receives an award or
			 settlement of more than one hundred weeks that is not to be paid in a lump sum,
			 and there are not sufficient accrued weeks to satisfy the attorney's fee and
			 costs, the attorney may request collection of the commuted value of his or her
			 approved fee directly from the employer's representative
B. To request payment of the attorney's fee
			 in a lump sum, file a motion for Lump Sum Payment of Attorney's Fee according
			 to R.67-215 with the
			 Commission's Judicial Department.
(1) Attach
			 a completed Form 61 to the Motion. The Commission will commute the fee to
			 present day value as provided below.
(a) The
			 number of weeks to which the fee is equivalent is determined by dividing the
			 approved fee by the claimant's compensation rate.
(b) The present day value of the weeks is
			 determined according to the discount tables approved by the
			 Commission.
(c) The present day
			 value is multiplied by the compensation rate, resulting in the attorney's fee
			 reduced to present day value.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 13 - MEDICAL REPORTS, PHYSICIAN'S FEES AND HOSPITAL CHARGES › Section 67-1301 - Medical Reports

Current through Register Vol. 48, No. 6, June 28, 2024
A. A
			 medical practitioner or treatment facility shall furnish upon request all
			 medical information relevant to the employee's complaint of injury to the
			 claimant, the employer, the employer's representative, or the Commission.
			 Payment for services rendered may be withheld from any medical practitioner or
			 treatment facility who fails to comply with a request for this
			 information.
B. The employer's
			 representative shall submit to the Commission a report indicating the
			 claimant's final rating of permanent impairment.
C. A health care facility and a health care
			 provider may charge a fee for the search and duplication of a medical record
			 not to exceed the fee published in the Medical Services Provider
			 Manual.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 13 - MEDICAL REPORTS, PHYSICIAN'S FEES AND HOSPITAL CHARGES › Section 67-1302 - Maximum Allowable Payments to Medical Practitioners

Current through Register Vol. 48, No. 6, June 28, 2024
A. The Commission shall establish maximum
			 allowable payments for medical services provided by medical practitioners based
			 on a relative value scale and a conversion factor set by the Commission.
(1) The maximum allowable payments and any
			 policies governing the billing and payment of services provided by medical
			 practitioners shall be published in a medical services provider
			 manual.
(2) The Commission may
			 review and update the relative values and/or the conversion factor as
			 needed.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 13 - MEDICAL REPORTS, PHYSICIAN'S FEES AND HOSPITAL CHARGES › Section 67-1303 - Payments for Hospital Inpatient Services

Current through Register Vol. 48, No. 6, June 28, 2024
A. The Commission shall maintain a
			 prospective payment system based on diagnosis related groups with methodology
			 and prices established by the Commission for the payment of inpatient hospital
			 services.
(1) Hospitals submit claims for
			 payment to the employer or insurance carrier on the Form 14A.
(2) The Commission recognizes the current
			 uniform billing (UB) form as its Form 14A for hospitals.
(3) The employer or insurance carrier
			 reviewing the claim for payment shall be entitled to a copy of the applicable
			 hospital records at no charge.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 13 - MEDICAL REPORTS, PHYSICIAN'S FEES AND HOSPITAL CHARGES › Section 67-1304 - Payments for Hospital Outpatient Services and Ambulatory Surgical Centers

Current through Register Vol. 48, No. 6, June 28, 2024
A. The Commission
			 shall develop a prospective payment system for outpatient hospital services and
			 services rendered by ambulatory surgical centers.
B. Until such time as the prospective payment
			 system is operational the payments for hospital outpatient services and
			 ambulatory surgical centers shall be set by the Commission based on a discount
			 to the provider's usual and customary charge.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 13 - MEDICAL REPORTS, PHYSICIAN'S FEES AND HOSPITAL CHARGES › Section 67-1305 - Medical Bill Review

Current through Register Vol. 48, No. 6, June 28, 2024
A.
			 Upon receipt of a medical claim, the employer or carrier shall review the bill
			 for compliance with the policies and maximum payments set forth by the
			 Commission.
(1) An employer or insurance
			 carrier who reviews medical claims for payment must apply to the Commission for
			 approval to review and reduce medical bills. An employer who is not an approved
			 reviewer may solicit the services of an approved bill reviewer, but may not
			 rely on the Commission for bill review services.
(2) In cases where the billing involves
			 unusual or complex circumstances the bill may be sent to the Commission's
			 Medical Services Division for initial review.
(3) Whenever a charge is reduced to the
			 Commission's maximum allowable payment, the reviewer shall include on the
			 explanation of benefits (EOB) form a statement which explains the reduction and
			 indicates the provider's right to appeal the reduction as outlined in
			 subsections B and C.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 13 - MEDICAL REPORTS, PHYSICIAN'S FEES AND HOSPITAL CHARGES › Section 67-1306 - Medical Advisory Committees

Current through Register Vol. 48, No. 6, June 28, 2024
A. The Commission may convene advisory
			 committees to make recommendations to the Commission on medical matters such as
			 medical payment systems, rate setting methodology or other medical policy
			 issues.
B. The advisory committees
			 are convened at the Commission's discretion.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 13 - MEDICAL REPORTS, PHYSICIAN'S FEES AND HOSPITAL CHARGES › Section 67-1307 - Rehabilitation Professionals

Current through Register Vol. 48, No. 6, June 28, 2024
A.
			 Rehabilitation professionals are coordinators of medical rehabilitation
			 services, including but not limited to state, private, or carrier based,
			 whether on site, telephonic, in or out of state.
B. The role of a rehabilitation professional
			 is to ensure the primary concern and commitment in each workers' compensation
			 case is to advance the medical rehabilitation of the injured worker.
C. A rehabilitation professional must comply
			 with S.C. Section
			 42-15-95
			 and R.67-1308
			 when communicating with a health care provider who provides examination or
			 treatment for any injury, disease, or condition for which compensation is
			 sought. A rehabilitation professional shall possess one of the following
			 certifications:
(1) Registered Nurse -
			 RN;
(2) Certified Rehabilitation
			 Counselor - CRC;
(3) Certified
			 Registered Rehabilitation Nurse - CRRN;
(4) Certified Disability Management
			 Specialist - CDMS;
(5) Certified
			 Occupational Health Nurse - COHN; or
(6) Certified case manager - CCM.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 13 - MEDICAL REPORTS, PHYSICIAN'S FEES AND HOSPITAL CHARGES › Section 67-1308 - Communication Between Parties And Health Care Providers

Current through Register Vol. 48, No. 6, June 28, 2024
A. A health care provider who provides
			 examination or treatment for any injury, disease or condition for which
			 compensation is sought under the provisions of this title may discuss or
			 communicate an employee's medical history, diagnosis, causation course of
			 treatment, prognosis, work restrictions, and impairments with the insurance
			 carrier, employer, their respective attorneys or certified rehabilitation
			 professionals or the Commission without the employee's consent.
B. The claimant must be:
(1) Notified by the employer, carrier or its
			 representative requesting the discussion or communication with the health care
			 provider in a timely fashion, but no less than ten days notice unless the
			 parties agree otherwise. Notification may be oral or in writing.
(2) Allowed to attend and participate, along
			 with claimant's attorney, if any.
(3) Advised by the employer, carrier or its
			 representative requesting the discussion or communication prior to the
			 discussion or communication.
(4)
			 Provided a copy of the written questions at the same time the questions are
			 submitted to the health care provider and provided a copy of the response by
			 the health care provider.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 14 - ENFORCEMENT PROCEEDINGS › Section 67-1401 - Fines, Assessment and Review

Current through Register Vol. 48, No. 6, June 28, 2024
A. The Commission is authorized to assess
			 fines as provided in this Chapter and the Act. The following provisions shall
			 apply to the assessment and request for review of a fine against a party or its
			 representative.
B. The department
			 or division of the Commission charged with assessing the fine shall provide
			 written notice of a failure to file a form and an assessment.
(1) Within thirty days of the date of service
			 of the notice, the form must be filed and the assessment paid to the
			 Commission. A request for a director's review of the assessment may be filed
			 according to C below.
(2) Failure
			 to file the form and make prompt payment of an assessed fine or to request
			 review of the assessment as provided in C below shall result in an order
			 issued.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 14 - ENFORCEMENT PROCEEDINGS › Section 67-1402 - Unqualified Self-Insured Employer, Prosecution

Current through Register Vol. 48, No. 6, June 28, 2024
A. When it appears an employer is operating
			 in violation of this Chapter and the Act by failing to provide proof of
			 compliance with the insurance provisions of this Chapter and the Act, the
			 Commission shall institute an investigation of the employer and its operations.
(1) An officer of the department is
			 authorized to conduct the investigation.
(2) The officer shall gather information
			 necessary to make a recommendation concerning the employer's compliance with
			 the provisions of this Chapter and the Act.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 14 - ENFORCEMENT PROCEEDINGS › Section 67-1404 - Order and Rule to Show Cause, Hearings

Current through Register Vol. 48, No. 6, June 28, 2024
A. The Commission may issue an Order and Rule
			 to Show Cause requiring an appearance before a Commissioner.
(1) An Order and Rule to Show Cause is served
			 according to R.67-213.
(2) The
			 hearing shall be convened at the Commission's offices located in Columbia,
			 South Carolina unless otherwise provided by order of the Commission.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 15 - SELF-INSURANCE › Section 67-1501 - Self-Insurance, Application

Current through Register Vol. 48, No. 6, June 28, 2024
A. An
			 employer may apply to individually self-insure by filing a Form 7, Application
			 To Individually Self-Insure, with the Commission's Self-Insurance Division and
			 as follows.
(1) Complete and sign the Form 7
			 and attach to the form the following:
(a) A
			 two hundred fifty dollar application fee; and
(b) A statement describing in detail the
			 proposed claims administration program including the resume of each member of
			 the claims administration staff if claims will be administered by the employer,
			 or a copy of the service contract and quote for service fee if claims will be
			 administered by a third party claims administrator; and
(c) A description of an outside safety
			 consultant program and annual fee, if any; and
(d) Three year's audited financial
			 statements, audited according to generally accepted accounting principles, or a
			 10K report for each of the previous three years; and
(e) Quotes for excess insurance according to
			 R.67-1503.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 15 - SELF-INSURANCE › Section 67-1502 - Self-Insurance, Granting the Privilege and Providing Proof of Compliance

Current through Register Vol. 48, No. 6, June 28, 2024
A. Each application
			 in R.67-1501
			 is reviewed by the Commission's Self-Insurance Division. The Commission may
			 approve an application contingent on the applicant's filing the proper forms
			 and documents evidencing proof of compliance.
(1) Proof of compliance consists of the
			 following documents filed with the Self-Insurance Division.
(a) A copy of the excess insurance policy
			 according to R.67-1503;
			 and
(b) A Form 8, Proof of
			 Compliance, Surety Bond, or a Form 8A, Proof of Compliance, Securities Pledge,
			 or a Form 8B, Proof of Compliance, Memorandum of Understanding and Irrevocable
			 Letter of Credit; and
(c) Proof of
			 a reserve account, if applicable, according to R.67-1504;
			 and
(d) Compliance with the terms
			 and conditions for approval of the self-insurance program as ordered by the
			 Commission.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 15 - SELF-INSURANCE › Section 67-1503 - Proof of Compliance, Excess Insurance

Current through Register Vol. 48, No. 6, June 28, 2024
A. Each self-insurer shall purchase specific
			 excess insurance in an amount determined by the Commission. The Commission may
			 also require a self-insurer to purchase aggregate excess insurance, in addition
			 to specific excess insurance, depending on the self-insurer's financial
			 condition, size, loss history, and exposure. The Self-Insurance Division will
			 notify the self-insurer of the amount and type of excess insurance
			 required.
B. Provide proof of
			 excess insurance by filing a copy of the excess insurance policy with the
			 Self-Insurance Division.
(1) The self-insurer
			 may file an acceptable certificate of insurance, as proof of excess insurance
			 coverage, in lieu of a policy, for the first forty-five days following approval
			 to self-insure or a change in excess insurance carriers.
(2) The applicant shall file a copy of the
			 excess insurance policy within the period in R.67-1502B.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 15 - SELF-INSURANCE › Section 67-1504 - Proof of Compliance, Reserve Account, and Other Accounts

Current through Register Vol. 48, No. 6, June 28, 2024
A. Each proposed
			 self-insurance fund shall establish a reserve account and other accounts as
			 necessary. To provide proof of a reserve account, an officer of the fund shall
			 file an affidavit with the Self-Insurance Division within the time provided in
			 R.67-1502B.
(1) The affidavit shall state the
			 name of the bank, the account number and the current account balance.
(2) The fund initially shall deposit into the
			 reserve account not less than twenty-five percent of the first year's total
			 estimated annual standard premium.
(3) The fund initially shall deposit into
			 accounts other than its reserve account seventy-five percent of the first
			 year's total estimated annual standard premium from which expenses may be
			 paid.
(4) After the self-insurance
			 fund's first year, the fund shall maintain the reserve at no less than
			 twenty-five percent of the total estimated annual standard premium for all
			 members of the fund.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 15 - SELF-INSURANCE › Section 67-1505 - Proof of Compliance, Surety Bond

Current through Register Vol. 48, No. 6, June 28, 2024
A. File a Form 8, Proof of Compliance, Surety
			 Bond, with the Self-Insurance Division within the time provided in
			 R.67-1502B.
			 The amount of the bond is determined by the Commission based on an analysis of
			 the total self-insurance program including but not limited to an analysis of
			 the applicant's excess insurance, loss history, and financial
			 condition.
B. The minimum bond
			 amount is two hundred and fifty thousand dollars.
C. The following provisions shall apply to a
			 bond.
(1) The bonding company must be
			 licensed by the South Carolina Department of Insurance.
(2) The bond shall be deemed continuous
			 beginning with the date of contingent approval of the self-insurance program
			 and continuing until sixty days after a written notice of cancellation is
			 reviewed by the Self-Insurance Division.
(3) When the Self-Insurance Division receives
			 a bond cancellation notice, the self-insured is notified to replace the bond
			 before the expiration of the original bond. The Commission shall institute
			 revocation proceedings upon the failure to renew or replace the bond as
			 described in R.67-1513.
South Carolina Code of Regulations › Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION › Article 15 - SELF-INSURANCE › Section 67-1506 - Proof of Compliance, Securities Pledge

Current through Register Vol. 48, No. 6, June 28, 2024
A. The Commission in its discretion may
			 accept a pledge of securities issued by this State or the federal government as
			 proof of compliance instead of a bond or letter of credit.
B. The Commission shall determine the amount
			 of securities required by R.67-1505A
			 and shall notify the self-insurer of the amount.
C. The securities shall be held by a trust
			 department of a South Carolina bank and pledged to the South Carolina Workers'
			 Compensation Commission.
D. To
			 pledge securities, the bank shall provide an acceptable safekeeping receipt.
(1) The bank safekeeping receipt must outline
			 the details of the securities, and pledges the securities to the South Carolina
			 Workers' Compensation Commission.
(2) File the bank safekeeping receipt with
			 the Self-Insurance Division within the time provided in R.67-1502B.