Chapter 67

67-1001. Parties, Generally. 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 per…

67-1002. Occupational Disease, Waiver of Claim. 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 disabili…

67-101. South Carolina Workers’ Compensation Commission, Location, Transaction of Business. A. The South Carolina Workers’ Compensation Commission’s offices are located in Columbia, South Carolina. B. The Commission transacts business weekdays 8:30 A.M. to 5:00 P.M., excluding St…

67-1101. Total or Partial Loss or Loss of Use of a Member, Organ, or Part of the Body. 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 S…

67-1102. Loss of Hearing. 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 Permane…

67-1201. Appearances Before the Commission. 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 no…

67-1205. Determining a Reasonable Fee. 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 th…

67-1207. Collection of Attorney’s Fee in a Lump Sum. 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 reques…

67-1301. Medical Reports. 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 render…

67-1302. Maximum Allowable Payments to Medical Practitioners. 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 allowab…

67-1303. Payments for Hospital Inpatient Services. 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…

67-1304. Payments for Hospital Outpatient Services and Ambulatory Surgical Centers. 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 sy…

67-1305. Medical Bill Review. 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 appl…

67-1306. Medical Advisory Committees. A. The Commission may convene advisory committees to make recommendations to the Commis- sion on medical matters such as medical payment systems, rate setting methodology or other medical policy issues. B. The advisory committees are convened…

67-1307. Rehabilitation Professionals. 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…

67-1308. Communication Between Parties And Health Care Providers. 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 medi…

67-1401. Fines, Assessment and Review. 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 divi…

67-1402. Unqualified Self-Insured Employer, Prosecution. 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 Commis- sion shall institute an i…

67-1404. Order and Rule to Show Cause, Hearings. 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 o…

67-1501. Self-Insurance, Application. A. An employer may apply to individually self-insure by filing a Form 7, Application To Individual- ly 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 foll…

67-1502. Self-Insurance, Granting the Privilege and Providing Proof of Compliance. 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 documen…

67-1504. Proof of Compliance, Reserve Account, and Other Accounts. 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…

67-1506. Proof of Compliance, Securities Pledge. 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 secu…

67-1507. Proof of Compliance, Irrevocable Letter of Credit. A. The Commission in its discretion may accept a Form 8B, Proof of Compliance, Memorandum of Understanding and Irrevocable Letter of Credit, as proof of compliance instead of a surety bond or securities. The Commission w…

67-1508. Effective Date of R.67-1503. A. Regulation 67-1503 shall not apply retroactively to a self-insurance program existing on or before the effective date of these regulations. B. Self-insurance programs approved on or before the effective date of these regulations may contin…

67-1510. Financial Analysis and Reports. A. A self-insured employer shall file audited financial statements, prepared in accordance with generally accepted accounting principles, or the United States Securities & Exchange Commission’s Form 10K with the Self-Insurance Division wit…

67-1511. Audits. A. The Self-Insurance Division or its representative may audit the self-insured employer and self- insurance fund. The audit may include examination of evidence supporting the information filed on the Form 10, Self-Insurance Tax Return, Form 11, Self-Insurer’s Qu…

67-1512. Voluntary Withdrawal from a Self-Insurance Program and Cancellation of a Member’s Self-Insurance Privileges. A. A self-insured employer may withdraw its privileges to self-insure by notifying the Self-Insurance Division in writing of its intent to withdraw. Withdrawal sh…

67-1516. Municipalities and Political Subdivisions. A. An application of a municipality or political subdivision shall be approved without submission of proof of financial ability and without deposit of bond or other security. B. Assurance must be provided that provisions shall b…

67-1601. Expenses Incurred in Receiving Medical Treatment, Reimbursement. A. The expenses incurred for travel to receive medical attention which shall be reimbursed to the claimant are: (1) Mileage to and from a place of medical attention which is more than five miles away from h…

67-1603. Calculating the Compensation Rate. A. The employer’s representative shall calculate the claimant’s compensation rate by completing a Form 20, Statement of Earnings of Injured Employee. When using a Form 20 results in a compensa- tion rate that is not fair and just to eit…

67-1605. Lump Sum Payment. A. The employer’s representative shall pay, in lump sum, a settlement or award which is less than one hundred weeks. When a settlement or award is more than one hundred weeks, the Hearing Commissioner may order a lump sum payment or the claimant may req…

67-1606. Lump Sum Payment in a Claim Involving a Fatality. A. When the Commissioner orders or approves a lump sum payment to whole dependent(s), the accrued weeks are subtracted from the number of weeks awarded. (1) The present worth of the weeks remaining is calculated and multi…

67-1701. Repeal of Existing Regulations and Adoption of Articles 1 through 17, Inclu- sive. A. Existing Regulations 67-1 through 67-38, inclusive, are repealed effective ninety days from the date of the General Assembly’s approval of the adoption of Chapter 67, Article 1 through …

67-1801. Mediation. A. This mediation regulation is established to resolve disputes without the necessity of a hearing. The purpose is to afford a meaningful opportunity to the parties to achieve an efficient and a just resolution of their disputes in a timely and a cost-effectiv…

67-1802. Mediation Required with Certain Claims. A. The Commission orders that the following claims must be mediated prior to a hearing: (1) Claims for permanent and total disability arising under either Section 42-9-10 or Section 42-9-30(21); (2) Claims arising under Chapter 11 …

67-1803. Mediation Requested by Parties. The parties may request mediation by the proper submission of a Form 21, Form 50, Form 51, or the response to the Form 21, indicating a request for mediation. Except as provided in section 67-1802 A, either party may object to mediation by…

67-1804. Selection of Mediator and Required Schedule. A. The parties may consent to use any mediator who is duly qualified. The mediator must be certified as a mediator per the certification process established by the South Carolina Bar Association. B. The parties must select a m…

67-1805. Parties Represented. In addition to their attorney being present, each party shall provide a representative, who shall attend the mediation in person or via telephone. The representative shall have authority to enter into negotiations, in good faith, to resolve the issue…

67-1806. Mediation Communications Confidential. A. All communications and statements that take place within the context of mediation shall be confidential and not subject to disclosure. Such communications or statements shall not be disclosed by any mediator, party, attorney, or …

67-1807. Expense of Mediation. The parties shall share the cost of mediation equally, unless otherwise agreed by the parties, or as otherwise ordered by the Commission. HISTORY: Added by State Register Volume 37, Issue No. 6, eff June 28, 2013.

67-1808. Penalties. Any party who refuses or neglects to act in good faith during the mediation may be subject to a fine not to exceed the actual cost of the mediation. Any party who believes this provision has been violated may file a Motion for a Rule to Show Cause before the j…

67-1809. Forms Required Upon Completion. A Form 70 shall be filed by the mediator with the Judicial Department at the conclusion of the mediation. A Form 70 shall not become a part of the Commission’s file, and will solely be used for tracking purposes. The Commission shall not p…

67-201. Application of Regulations. A. These regulations are entitled to a liberal construction in the furtherance of the purpose for which the South Carolina Workers’ Compensation Law is intended. B. In doubtful cases, the application of these regulations shall be construed in f…

67-202. Words and Phrases, Defined. A. The definition of words and phrases used in this Chapter include: (1) Accident Reporting Division: A division of the Commission responsible for receipt and processing of the employer’s first report of injury, Form 12A (ACORD 4) and Form 12M.…

67-203. Official Forms and Documents. A. The Commission prepares and approves all required forms. A person shall use a Commission form and shall not substitute another document for a form. Reproduction of a form the same size is permitted, provided content is not altered. B. Comm…

67-204. Completing Forms. A. A person filing a form with the Commission shall complete each information blank on the form. Each form shall contain the W.C.C. file number and the employer’s FEIN, if known. B. The Commission may return an incomplete form to the sender with an expla…

67-206. Filing a Claim. A. To file a claim, file with the Commission’s Claims Department a Form 50, Form 52, or a letter as provided below. B. To file a claim on a Form 50 or Form 52, mark the box at the signature line which states ‘‘I am filing a claim. I am not requesting a hea…

67-207. Requesting a Hearing, Claimant. A. A hearing shall be requested by filing a Form 15, Form 50 or Form 52 with the Commission’s Judicial Department as provided below: (1) The party shall mark the box at the signature line on the Form 50 or Form 52 which states, I am request…

67-208. Requesting a Hearing, Employer. A. The employer’s representative may request a hearing by filing the appropriate form as provided below with the Commission’s Judicial Department and serving the form pursuant to R.67-211. B. To request a hearing for permission to pay compe…