Expert Tips for Avoiding Fines and Penalties in Claims Management

Best Practices to Avoid Fines & Penalties Sonji Spann, Director of Claims Missy Lord, Lead Resolution Manager

Forms must be complete, accurate and timely.

Form 12-A - First Report of Injury Employer must keep record of all injuries. Carrier must file the form 12A with the WCC when $2,500 in medical has been spent, a claimant has compensable lost time, or there is permanency. In denied claims, Carrier must file form 12A with a form 19 and denial letter to WCC. Carrier must report all fatalities to the WCC. If filed with WCC, always remember to close file with a Form 19.

Form 12-A Regulation 67-411 Must be submitted within ten (10) business days of employer s representatives' knowledge of the accident if the accident meets the criteria to file with the SC WCC.

What If.. They are not a statutory employee of my employer? An attorney files a claim with the SC WCC and I didn t get a copy? The attorney files a claim for the incorrect date of injury? If a FROI is filed in SC jurisdiction in error?

Form 15-I - Temporary Compensation Report Section I used to start, change, or adjust TTD or TPD benefits Must be served on Claimant with first check and filed with SC WCC within 10 days of payment Must be filed when paying an additional period of benefits Must be filed when correcting the compensation rate

Form 15-I - Temporary Compensation Report Payment of Temporary Compensation: Check One Initial Period Additional Period Corrected Compensation Rate Section I-A(Temporary Comp) and I-B (Temporary Partial): Compensation Rate Disability Date Began First Date of Payment Calculation of Temporary Partial Rate: MUST BE COMPLETED Section C: Salary in Lieu of Temporary: Please check Total or Partial ______ amount per week Disability Date Begin First Date of Payment NOTE: Please do not put varies for the compensation rate

What if.. I forget to file it within 10 days? I don t have actual wages from the employer yet?

Form 15-II - Temporary Compensation Report Used to stop payments within 150 days following notice of injury to employer. Must comply with at least one of the specific reasons set forth in the form: Claimant has returned to work for 15 days; Claimant signs Form 17; Claim is denied based on good faith investigation; Light duty is being provided by employer; or Claimant refuses medical treatment. File with WCC and serve on Claimant or attorney within ten days.

Form 15-II - Temporary Compensation Report Compensation stopped within 150 days of Date Notice to Employer The date compensation payment stopped. A reason must be checked. Form must be signed by Claims Administrator and dated.

What if.. They return within the 150 days but the 10 day filing requirement is after 150 days, do I need a Form 17 instead? How do I know it has been accepted?

Form 15 Regulations 67-503 & 67-504 Section I Filed within 10 days from the date of the first payment of compensation Section II Filed immediately to give notice compensation has been stopped

Form 15-S - Supplemental Report of Varying Temporary Partial Payments Used only where TPD payments vary in amount from week to week File every 6 months with Form 18. File Form 15(I) to reflect initial payment of TPD or TPD payments where the amounts do not vary.

Form 15 S - Supplemental Report of Varying Temporary Partial Payments It is needed when temporary partial varies form week to week. Initial temporary partial must be reported on 15-1B. Supplemental Report of Varying Temporary Partial Payments From _______ through _______, Claimant was paid $ _______ per week as temporary partial compensation. The weekly wage before the injury was $ _______. The weekly wage for this period was $ _______. Supplemental payments shall be reported on a Form 15S, to be filed with the document(Form 17 or 19) stopping that period of temporary partial compensation or with the Form 18. PLEASE DO NOT PUT VARIES AS THE COMPENSATION RATE

Form 15 S Regulations 67-503 Supplemental payments shall be reported on a Form 15S, to be filed with the document stopping that period of temporary partial compensation(Forms 17or 19) or with the Form 18.

Form 17 - Receipt of Compensation Use if Claimant agrees he or she is able to return to work in some capacity or returns to work at the same or similar wages and voluntarily agrees to have his benefits stopped. File and serve Form 15(II) instead of Form 17 if within 150 days; keep Form 17 in your file. In order to stop TTD after 150 days of injury notice, a form 17 must be signed and filed. If Claimant does not sign a form 17, defense counsel must file a form 21.

Form 17 - Receipt for Compensation Must have the Claimant and Employer Representative s signatures. The dates of compensation must match the dates filed on previous Form 15 s.

Form 17 Regulations 67-505 Signed Form 17 must be filed no later than 31 days from the date the claimant returned to work to terminate temporary compensation.

What if.. I am unable to locate the employee? If they refuse to sign it? Can I just stop their benefits if I know they have returned to work? They die and have been receiving benefits over 150 days?

Form 18 Periodic Report Used to reflect progress of claim and action requests. Must be filed every 6 months following accident date or SC WCC will fine carrier. A big source of fines!

Form 18 - Periodic Report The Form 18 provides the dates and amount of compensation paid and amount of medical paid at the time of submission. This report is due six months after the alleged date of injury and six months thereafter until Commission s file is closed. For example, if date of injury is 2/19: Form 18 s are due 8/19 and 2/19. Example: Form 18 must be filed between 2/9 - 3/1 for Feb. due date and between 8/9 8/29 for the Aug due date.

Form 18 Regulation 67-413 You have 10 days before and after the due date to file a Form 18 in order to avoid a fine. Form 18 s filed outside of this 20 day grace period could possibly receive a fine. Example: If the Date of Injury is Feb. 19. Form 18 must be filed between 2/9 - 3/1 for Feb. due date and between 8/9 8/29 for the Aug due date.

What if.. A claim was medical only and not reported right away to SC WCC is it 6 months from the date it was reported or from DOI? The form was filed before the 20 day window, will you receive a fine?

Form 19 Status Report and Compensation Receipt Must file to deny claim (with denial letter) within 10 days of denial Must file to close claim at WCC Can be amended later.

Form 19 Status Report and Compensation Receipt Must be filed by employer s representative within 16 days of the date final payment of compensation. Must be filed when claim is denied and must have a copy of the Denial Letter notifying the Claimant/Attorney of the denial. Must always have the Employer s Representative signature. Must have Claimant s signature when settlement has been paid. Must list compensation paid on claim and the dates must match the dates previously filed on Form 15 s and 17 s Settlement amount must be listed on the Form 19 Final medical or 14B must accompany Form 19 when medicals are over 2500.00 Note: If file is closed and then reopens, you must file another Form 19.

Form 19 42-9-270 Required to close all files even if no compensation has been paid (R. 67-414) Due within 16 days of final payment of compensation (Fine $50) Must be filed when a claim is denied along w/ a copy of the Denial Letter. ($200 Fine)

What if.. I don t get final medical records until after the 16 days, am I going to get a fine? I reopen my file to pay a straggling medical bill do I need to file another Form 19 to show the additional medical treatment paid? I can not obtain injured workers signature on the Form 19? I submit a Form 19 to deny a claim without a copy of the denial letter with it?

Failure to Respond to Request $200.00 Fine Carrier has 30 days to respond to request Forms not complete Forms require signatures Additional information is needed File is missing a Form Denial Letter not submitted Final Medical/14B not submitted

What if.. I don t get a copy of the notice?

Forms must be filed via email or SC WCC Portal via our website wcc.sc.gov To Submit a: Use This Email Address: Form 15 Form15@wcc.sc.gov Form 15S Form15@wcc.sc.gov Form 17 Form17@wcc.sc.gov Form 18 * Form18@wcc.sc.gov Form 19 Form19@wcc.sc.cov Form 20 Form20@wcc.sc.gov *Form 18 s can be submitted via EDI Subject Line Format: WCC# Form15 WCC # Form15 WCC# Form17 WCC# Form18 WCC# Form19 WCC# Form20

What is the proper procedure for a carrier to contest a fine? Carrier may appeal within 30 days of the fine being assessed (R67-1401). Send appeals to: Claim Fines: claimsfines@wcc.sc.gov, 12A/FROI: froifines@wcc.sc.gov Judicial Fines: kgoodale@wcc.sc.gov Response will be sent out to rescind, reduce, or uphold the fine. Where to appeal a fine is noted in the 2ndparagraph of the Fine Notice.

Reminders Form 17 and Form 19 are receipts. The information listed on these forms must reflect all the activity that has happen throughout the claim. If you are unable to obtain a signed Form 17, you must file for a Form 21 Hearing or file a Motion to Certify the Form 17. If you are unable to obtain a signed Form 19, you must file a Motion to Certify the Form 19. You could be fined for a Form 18 filed outside of the 20-day window. If case is settled, you must obtain the injured workers signature on the Form 19, . When paying a fines, please include the injured workers name, invoice # and WCC # on the check. Fines can be paid electronically via SC WCC Portal SC WCC Examiners will return a form to you for additional information, please respond to the examiner that has made the request and the information must be provided within 30 days. If a form is returned to the carrier, it will be indicated on Ecase. Please review Ecase daily to ensure your forms are filed and if not contact SC WCC. You will receive a Confirmation Email each time you file a form. Please keep the Confirmation Email to appeal a fine.

Communication claimsgroup@wcc.sc.gov

Thank You!!!