South Carolina > Workers Comp
SCWCC Coverage Coding Sheet For Attorneys - South Carolina
| SCWCC Coverage Coding Sheet For Attorneys Form. This is a South Carolina form and can be used in Workers Comp . |
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SCWCC COVERAGE CODING SHEET FOR ATTORNEYS Today's Date: ____________ Claimant's name: _____________________________________________ SSN: ____________________ Date of Accident/Loss: ______________ Employer:____________________________________________________ Insured Name: _______________________________________________ (If different from Employer) Carrier Information : Name: Address: Phone #: Carrier Code #: Coverage verified by: Policy Number: Policy Effective Dates: FEIN: WCC Attorney #: _____________________ Check here if no coverage found: ___________ Attach a copy to all Letters of Representation and/or Forms 50/52 filed with the Commission & Carrier, until a WCC# is established. Insurance coverage can be obtained by calling the Commission's Coverage Division at (803) 737-5708 American LegalNet, Inc. www.USCourtForms.com
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