Notice Of Third Party Action Employer Carrier
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Notice Of Third Party Action Employer Carrier Form. This is a South Carolina form and can be use in Workers Comp.
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Tags: Notice Of Third Party Action Employer Carrier, S-1, South Carolina Workers Comp,
I.C. File #:
South Carolina Workers’ Compensation Commission
1612 Marion St.
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
EMPLOYER CARRIER
In the Workers’ Compensation Claim of
, Employee
, Claimant(s)
vs.
, Employer
, Carrier
TO THE SOUTH CAROLINA WORKERS’ COMPENSATION COMMISSION and the above-named employee or claimant(s) and
(any other person entitled to sue):
PLEASE TAKE NOTICE that an action has been commenced against
as defendant(s) in the Court of
County of
and State of
under date of
,
.
Workers’ Compensation Carrier or
Self-Insurer Employer
DATED:
Attorney for Carrier or Self-Insurer
Employer
A copy of this form must be served upon the South Carolina Workers’ Compensation Commission, the injured employee or his surviving Workers’ Compensation
beneficiary and any other person entitled to sue the third party by personal service, registered or certified mail within ninety (90) days after statutory assignment
that the right of action has passed to the carrier or self-insurer employer; and attached hereto is Form No. S-3, Entitlement to Right of Action.
WCC Form # S-1
Rev. 1986
S-1
Notice of Third Party Action
Employer Carrier
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