Notice Of Third Party Action Employee {S-2}

I.C. File #: South Carolina Workers' Compensation Commission 1333 Main Street, Suite 500 P.O. BOX 1715 Columbia, SC 29202-1715 (803) 737-5675 The use of this form is required under the provisions of the South Carolina Workers' Compensation Law. NOTICE OF THIRD PARTY ACTION EMPLOYEE In the Workers' Compensation Claim of , Employee , Claimant(s) vs. , Employer , Carrier TO THE SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION and the above-named Carrier or Self-Insurer Employer: PLEASE TAKE NOTICE that an action has been commenced against as defendant(s) in the Court of County of under date of and State of , . Employee or Surviving Workers' Compensation Beneficiary DATED: Attorney for Employee or Surviving Workers' Compensation Beneficiary A copy of this form must be served upon the South Carolina Workers' Compensation Commission, the Workers' Compensation carrier or self-insurer employer by personal service, registered or certified mail within thirty (30) days after third party action commenced; and, the third party action must be commenced within one (1) year after employer-carrier accepts liability for or makes payment of compensation as provided in the Workers' Compensation Law. WCC Form # S-2 Rev. 1986 S-2 Notice of Third Party Action Employee American LegalNet, Inc. www.FormsWorkFlow.com