SCWCC Coverage Coding Sheet For Attorneys
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SCWCC Coverage Coding Sheet For Attorneys Form. This is a South Carolina form and can be use 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)
Insurance Carrier:
Name:
Address:
Phone #:
Carrier Code #:
FEIN:
Policy Number:
Policy Effective Dates:
Coverage verified by:
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.
Employer insurance coverage information can be obtained through our website, wcc.sc.gov, or by calling the
Commission’s Coverage Division at (803) 737-5708.
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