South Carolina Workers’ Compensation Commission

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…

67-1103. Amputation of Finger or Toe. 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…

67-1104. Health Care for Injury Resulting in Hernia. 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 i…

67-1105. Loss of Vision. 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…

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…

67-1202. Attorney’s Letter of Representation. 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 at…

67-1203. Withdrawing Representation. 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 …

67-1204. Reporting Attorneys Fees for Approval. 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 sha…

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…

67-1206. Costs. 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 …

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…

67-1503. Proof of Compliance, Excess Insurance. 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…

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…

67-1505. Proof of Compliance, Surety Bond. 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 …

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…

67-1509. The Self-Insurance Program, Amendments to and Renewal of. A. The Commission may amend the self-insurance program when analysis of the program shows a significant change in the number of employees in the state, the financial condition, losses, the excess insurance program…

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…

67-1513. Revocation Proceedings. A. The Commission institutes revocation proceedings by Order and Rule To Show Cause. B. The self-insurer or self-insurance fund shall be afforded an opportunity to be heard and the right to review as in other cases.

67-1514. Self-Insurance Tax. A. Each self-insured employer and each self-insurance fund shall file a Form 10, Self-Insurance Tax Return, and make payment of its tax liability according to the Act. B. The Commission may assess a penalty and institute revocation proceedings for fai…

67-1515. Confidentiality of Information. A. Commission records and information relating to the solvency and financial condition of an employer under the authority granted by this Chapter and the Act shall not be subject to inspection; nor shall any information be directly or indi…

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…

67-1602. Payment of Compensation. A. Unless otherwise ordered by the Commission, the employer’s representative shall pay all compensation directly to (1) the claimant or (2) the guardian, if the claimant is a minor or incapacitated person, or (3) another person approved by a cour…

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 …