Can the guide be signed electronically?

Yes. Electronic signatures are legally valid under the ESIGN Act and UETA when intent, consent, attribution and retention are present; verify exceptions for specific court or testamentary documents.

Does HIPAA affect sharing claim records?

Yes. When medical information is part of a claim, handle disclosures under HIPAA rules and execute BAAs with service providers who access PHI.

Who must sign the guide on behalf of the employer?

An authorized officer or designated representative with signature authority should sign; document the signer’s title and retain proof of authority to bind the employer.

What if an employee refuses electronic delivery?

Provide a paper alternative and document the employee’s choice; consumer-facing records often require a disclosure of the right to a paper copy under ESIGN.

How do I correct an incorrect policy entry?

Issue an amendment or corrected policy page, have the authorized signer execute it, and retain both versions with a clear audit trail noting the reason for correction.

Are notarization or witnesses required?

Not generally for routine policy guides, but specific endorsements or power-of-attorney documents may require notarization or witnesses under state law; verify with counsel.

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South Carolina Workers Compensation Policy Guide

South Carolina Workers Compensation Policy Guide

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Statement of Earnings of Injured Employee

South Carolina Workers' Compensation Commission

P.O. Box 1715 • 1612 Marion Street

Columbia, South Carolina 29202-1715

(803)737-5700

WCC File #

Carrier File #

Carrier Code #

Employer FEIN

Claimant's Name

SSN

Employer's Name

Address

City

State

Zip

Address

City

State

Zip

Home Phone #

Work Phone #

Insurance Carrier

Preparer's Name

Phone #

A. Total Wages Paid

1. Check Applicable Method:

Report of earnings of injured employee based on four completed quarters.

Report of earnings of injured employee who did not complete four quarters based on actual time worked.

Report of earnings of similar employee. Injured employee did not work sufficient time before alleged injury.

Report of earnings of injured employee based on alternative method because Form 20 results in a compensation rate that is not fair and just.

(Attach documentation to show how average weekly wage and compensation rate were calculated.)

Date of injury:

Hire Date:

2. List total wages paid as reported to Employment Security Commission on the Employer Quarterly Contribution and Wage Reports during the four quarters immediately preceding the quarter in which the injury occurred. Do not include the quarter during which the injury occurred.

Quarter	Ending Date	Total Wages Paid
1st
2nd
3rd
4th

Total Paid 2.

3. List total value of other allowances of any character made in lieu of wages during four quarters above.

4. Add lines 2 and 3. TOTAL WAGES PAID:

5. List total number of weeks paid to employee during the four quarters immediately preceding the quarter in which the injury occurred.

B. Average Weekly Wage

6. To calculate average weekly wage, divide total wages (line 4) by total weeks paid (line 5). AVERAGE WEEKLY WAGE:

C. Compensation Rate

7. The general rule for calculating the compensation rate is to multiply average weekly wage (line 6) by .6667. Estimate compensation rate by multiplying average weekly wage (line 6) by .6667. See part 8 below to determine the actual compensation rate.

8. The compensation rate is as follows (choose one):

When average weekly wage (line 6) is less than $75.00, the compensation rate is the average weekly wage. Enter average weekly wage on line 8.

When the estimated compensation rate (line 7) is less than $75.00 and average weekly wage (line 6) is more than $75.00, the compensation rate is $75.00. Enter $75.00 on line 8.

When the estimated compensation rate (line 7) is more than the maximum compensation rate for the year in which the injury occurred, enter the maximum compensation rate for the year in which the injury occurred on line 8.

Employee is within the exceptions listed in S.C. Code Ann. Section 42-7-65. List applicable exception here and enter appropriate compensation rate on line 8.

The calculated compensation rate (line 7) applies. Enter amount from line 7 on line 8.

Applicable exception / notes:

WEEKLY COMPENSATION RATE: 8.

Employees representative shall prepare a Form 20 and serve per R.67-211 a copy on the claimant within thirty days of beginning temporary compensation. See R.67-1603 when no temporary compensation is paid. NOTE: Average weekly wage represents average gross pay before taxes and other deductions. WHEN THE CLAIMANT DOES NOT AGREE WITH THE COMPENSATION RATE ONLINE 8, HE OR SHE SHOULD CONTACT THE EMPLOYER'S REPRESENTATIVE TO TRY TO REACH AN AGREEMENT AS TO THE COMPENSATION RATE. IF NO AGREEMENT CAN BE REACHED THE CLAIMANT SHOULD CONTACT THE CLAIMS DEPARTMENT AT (803)737-5723.

Signature of Employer Representative

Date

Claimant Signature

Date

What the South Carolina Workers Compensation Policy Guide Covers

The South Carolina Workers Compensation Policy Guide explains the core elements of employer-provided workers' compensation coverage in South Carolina, including policy structure, employer responsibilities, employee benefits, claim intake and timelines, and insurer duties. It clarifies how a written policy translates into on-the-job medical benefits, wage replacement, return-to-work obligations and dispute-resolution processes. The guide also summarizes documentation best practices, common administrative fields insurers expect, and how electronic workflows and eSignatures interact with federal frameworks such as ESIGN and UETA while remaining attentive to state-specific practice.

Why a Clear Workers Compensation Policy Guide Matters

A concise policy guide reduces confusion at claim time, helps ensure compliance with state rules, standardizes reporting and supports accurate premium assignment. It also protects employers and employees by documenting coverage details, limits, and notice procedures in a way that aligns with South Carolina expectations and federal eSignature standards.

Who Typically Prepares and Uses This Guide

Employers, HR professionals, risk managers and insurance brokers most often prepare and distribute a workers' compensation policy guide for staff and supervising managers.

Small and mid-size employers seeking consistent claim reporting across locations.
HR and safety officers responsible for employee onboarding and incident response.
Insurance brokers and risk advisers coordinating policy placement and audits.

External stakeholders such as insurers, claims adjusters and occupational health providers also rely on the guide to interpret coverage, reporting steps, and documentation requirements.

Step-by-step: Preparing and Issuing the Policy Guide

Follow this sequence to create, approve, and distribute a compliant workers' compensation policy guide within your organization.

01

Draft Content: Assemble policy language, benefits summary, and reporting steps.
02

Internal Review: Have HR and legal review for accuracy and state alignment.
03

Insurer Confirmation: Confirm policy numbers, limits, and claims contacts with insurer.
04

Distribution: Provide signed copies to employees and file centralized records.

Digital Distribution and Integration Considerations

Select platforms that support secure distribution, audit trails, and the integrations your HR and claims systems require.

Integrations: Salesforce, NetSuite, Google Workspace, Microsoft 365 integration options.
File Formats: PDF and DOCX support for policy templates and records.
Security: Encryption in transit and at rest required.

Typical Policy Guide Lifecycle and Filing Flow

This simplified flow describes how a policy guide moves from creation to claims interaction and archival.

Prepare Guide: Draft policy and define reporting instructions.
Approve & Sign: Authorized signatory executes the document.
Share with Employees: Distribute signed copies and record acknowledgements.
Use in Claims: Claims adjusters follow guide procedures during intake.

Configuring an Electronic Workflow for the Guide

Map fields and routing steps before sending to keep signatures and records auditable.

Field \| Configuration	Field Name \| Required/Optional
Policy Number Field	Required \| single-line text
Effective Date Field	Required \| date field MM/DD/YYYY
Claims Contact Field	Required \| email + phone
Employer Signature Field	Required \| signer authentication enabled

Common Timing and Filing Expectations

Timelines vary by insurer and by injury severity; use the guide to set internal deadlines for reporting, investigation, and insurer notification.

Employee Notice:

Employees should notify employer as soon as practicable, typically within days of injury.

Employer Report to Insurer:

Report first notice of loss promptly; many insurers expect initial notice within 24–72 hours for serious injuries.

Medical Treatment:

Authorize emergency care immediately; follow insurer preauthorization policies for nonemergencies.

Follow-up Investigation:

Complete internal incident review within 7–14 days to capture evidence.

Claim Closure:

Closure timing depends on treatment duration and dispute resolution processes.

Key Milestones from Policy Issue to Claim Resolution

Use these milestones to monitor compliance and progress when a workplace injury occurs.

01

Policy Issuance

Policy is effective and distributed to authorized staff and HR.

02

Employee Notice Received

Employer documents notice and initiates internal reporting steps.

03

Insurer Notification

Insurer receives first notice and opens claim file.

04

Claim Resolution

Medical benefits and wage replacement are concluded or disputed.

Common Preparation Mistakes to Avoid

Using ambiguous language about coverage limits and waiting periods that leads to misinterpretation during claims.
Failing to list a clear claims contact or updated phone and email information, delaying insurer intake.
Mismatching employer names or tax IDs between payroll records and the policy, complicating premium audits.
Not retaining signed employee acknowledgements or electronic receipts demonstrating distribution of the guide.

Penalties and Risks from Inaccurate or Missing Guidance

Late Reporting: Possible fines and increased claim costs

Misclassification: Higher premium assessments and audits

No Coverage: Liability exposure for uninsured claims

Recordkeeping Failures: Penalties under state or federal rules

Privacy Breach: HIPAA enforcement risk when medical records mishandled

Contract Disputes: Legal costs and prolonged resolution

Security and Compliance Essentials for Electronic Guides

Encryption: TLS 1.2/1.3 in transit

Data at Rest: AES-256 encrypted storage

Audit Trail: Timestamps, IP, action log

Regulatory: ESIGN and UETA compliant

Healthcare: HIPAA BAA available

Standards: SOC 2 Type II and ISO 27001

eSignature Pricing and Feature Snapshot for Policy Guide Workflows

Compare starting prices and key feature rows for common eSignature vendors. signNow appears first to reflect plan-level details and compliance capabilities relevant to policy execution.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial, no card	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
Envelope Cap	No cap	100 envelopes/user/year	Varies	Varies	Varies

Frequently Asked Questions and Troubleshooting

Answers to common questions about completing, executing and retaining a South Carolina Workers Compensation Policy Guide, with notes on electronic signing and secure recordkeeping.

Need help? Contact support

Can the guide be signed electronically?
Yes. Electronic signatures are legally valid under the ESIGN Act and UETA when intent, consent, attribution and retention are present; verify exceptions for specific court or testamentary documents.
Does HIPAA affect sharing claim records?
Yes. When medical information is part of a claim, handle disclosures under HIPAA rules and execute BAAs with service providers who access PHI.
Who must sign the guide on behalf of the employer?
An authorized officer or designated representative with signature authority should sign; document the signer’s title and retain proof of authority to bind the employer.
What if an employee refuses electronic delivery?
Provide a paper alternative and document the employee’s choice; consumer-facing records often require a disclosure of the right to a paper copy under ESIGN.
How do I correct an incorrect policy entry?
Issue an amendment or corrected policy page, have the authorized signer execute it, and retain both versions with a clear audit trail noting the reason for correction.
Are notarization or witnesses required?
Not generally for routine policy guides, but specific endorsements or power-of-attorney documents may require notarization or witnesses under state law; verify with counsel.

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Field \| Configuration	Field Name \| Required/Optional
Policy Number Field	Required \| single-line text
Effective Date Field	Required \| date field MM/DD/YYYY
Claims Contact Field	Required \| email + phone
Employer Signature Field	Required \| signer authentication enabled