Homepage Fill Out Your Wcc 58 Form
Article Structure

The WCC 58 form plays a crucial role in the workers' compensation process in South Carolina, serving as a tool for parties involved in a claim to outline essential aspects of their case before a hearing. This pre-hearing brief requires the claimant and employer to provide various types of information, including details about the nature of the injury or illness, compensation rates, and any facts or legal issues that are in contention. It also asks for specifics regarding potential witnesses and exhibits that may be presented during the hearing. By including impairment ratings, medical evidence, and the contact information for the treating physician, the WCC 58 form allows all parties to prepare adequately and address the important aspects of the claim in a structured manner. Furthermore, it highlights mediation options, indicating whether mediation has been requested, required, or conducted, offering a chance for parties to resolve disputes amicably before escalating to a hearing. Ensuring that this form is filled out accurately is essential, as it sets the stage for the hearing and influences the overall proceedings. Attendees are encouraged to file the WCC 58 form and proof of service on the opposing party to comply with necessary regulations, thus promoting a fair and informed hearing process.

Wcc 58 Example

South Carolina Workers’ Compensation Commission

1333 Main Street, Suite 500

P.O. BOX 1715

Columbia, SC 29202-1715

(803) 737-5675

www.wcc.sc.gov

PRE-HEARING BRIEF

WCC File No:____________

Claimant's Name:

 

 

 

 

 

 

 

 

 

Employer's Name:

 

 

 

 

 

 

Address:

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

 

 

 

City:

 

 

 

 

State:

 

Zip:

 

City:

 

 

 

State:

 

Zip:

 

Home Phone:

 

 

Work Phone:

 

 

 

Carrier:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Preparer's Name:

 

 

 

 

 

 

 

 

 

Preparer’s Phone #:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A claim for workers’ compensation benefits is made based on the following grounds:

 

Injury

Illness

Repetitive Trauma

 

 

1.

Compensation Rate:

 

2. AWW:

$

Date of Injury:

3.Type of injury and body part(s): ________________________________________________________________________________________________

4.Facts in controversy:

5.Legal issues involved:

6.Unusual aspects:

7.Witnesses (designate if expert):*

8.Exhibits:

9.Medical evidence (indicate report pursuant to R.67-612; deposition or appearance):

10.Name, address, and specialty, if any, of the treating physician:

11.Impairment rating(s); body part(s); physician and date of opinion:

12.I am amending my Form 50/51 in the following manner:

Mediation

a.Mediation is requested to be ordered pursuant to Reg. 67-1801 B.

b.Mediation is required pursuant to Reg. 67-1802.

c.Mediation is requested by consent of the Parties pursuant to Reg. 67-1803.

d.Mediation has been conducted by a duly qualified mediator and resulted in an impasse.

Questions regarding mediation may be submitted to mediation@wcc.sc.gov.

I certify I have served this document pursuant to Reg. 67-211 by delivering a copy to_______________________________________

address __________________________________________________________ on the _____ day of _______________20_____,

by

first class postage

certified mail

personal service

electronic service

I verify the contents of this form are accurate and true to the best of my knowledge.

Signature:

 

 

 

 

Email:

 

 

 

 

 

 

 

 

 

 

Date of hearing:

 

 

Time needed for hearing:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Questions about the use of this form should be directed to the Jurisdictional Commissioner. Refer to Regulations 67-204 through 67-211 and Regulations 67-601 through 67-615; as well as Regulation 67- 1801. File this form and proof of service on the opposing party according to R.67-611 and R.67-212. Do not send medical reports. * Commissioners reserve the right to admit expert witnesses at hearings.

WCC Form # 58

58

PRE-HEARING BRIEF

Revised 7/15

 

 

 

Form Characteristics

Fact Name Description
Purpose of the Form The WCC 58 form is used for submitting a Pre-Hearing Brief in workers' compensation cases in South Carolina.
Governing Regulations This form is governed by various regulations, including Reg. 67-204 through 67-211 and Reg. 67-601 through 67-615.
Submission Guidelines When filing the WCC 58, a copy must be served on the opposing party as stated in Regulation 67-611 and Regulation 67-212.
Contact Information The form includes necessary contact details for the South Carolina Workers’ Compensation Commission, such as address and phone number.

Guidelines on Utilizing Wcc 58

When filling out the WCC 58 form, it is essential to provide accurate and comprehensive information regarding your workers' compensation claim. Completing this document correctly can facilitate the processing of your claim and ensure that all relevant details are reviewed by the appropriate parties.

  1. Locate the WCC 58 form, which can be accessed through the South Carolina Workers’ Compensation Commission's website or obtained directly from their office.
  2. Fill in the WCC File Number at the top of the form.
  3. Provide the Claimant's Name and Employer's Name in the designated fields.
  4. Enter the Claimant's and Employer's addresses, including the City, State, and Zip code.
  5. Input the Home Phone and Work Phone numbers in their respective fields.
  6. Indicate the name of the insurance Carrier for the claim.
  7. List the Preparer's Name and Preparer’s Phone number.
  8. Identify the basis of your claim by selecting one of the following options: Injury, Illness, or Repetitive Trauma.
  9. Fill in the Compensation Rate and Average Weekly Wage (AWW), indicating the dollar amount next to each term.
  10. Enter the Date of Injury in the relevant field.
  11. Describe the Type of injury and the affected Body Parts in the provided space.
  12. Summarize the Facts in controversy concisely.
  13. List the Legal issues involved, using clear and specific language.
  14. Note any Unusual aspects related to your claim.
  15. Identify Witnesses, specifying if any are experts.
  16. Enumerate any Exhibits that will be submitted as part of your claim.
  17. Detail Medical evidence, indicating the report used according to R.67-612, and note any depositions or appearances.
  18. Provide the Name, address, and specialty of the treating physician.
  19. Record the Impairment rating(s), the corresponding body part(s), the physician's name, and the date of their opinion.
  20. State whether you are amending a Form 50/51 and describe how.
  21. If mediation is involved, select the applicable option and provide necessary details.
  22. Complete the certification section by indicating the method of service and filling in the date, recipient's name, and address.
  23. Ensure accurate completion of the Signature, Email, Date of hearing, and Time needed for hearing sections.
  24. Do not forget to verify all information is true and accurate to the best of your knowledge.
  25. Submit the completed form along with proof of service as required by the applicable regulations.

What You Should Know About This Form

What is the purpose of the WCC Form 58?

The WCC Form 58, known as the Pre-Hearing Brief, is used in the state of South Carolina for workers' compensation cases. It serves as a way for the parties involved to outline and summarize key information regarding their claim before an official hearing takes place. This form collects essential data, including the details of the injury or illness, the compensation rate, legal issues at stake, and the names of potential witnesses. By filling out this form, the involved parties ensure they provide all necessary background for the Commissioner to understand the case better.

Who should complete the WCC Form 58?

The WCC Form 58 should be completed by the claimant or their representative, such as an attorney. This ensures that all relevant information is accurately conveyed to the South Carolina Workers’ Compensation Commission. It is important that the form is filled out with care, as it can impact the progression of the case. If you are unclear on any section of the form, seeking assistance from legal counsel may be beneficial.

What information is required on the WCC Form 58?

The WCC Form 58 requires several specific pieces of information. You’ll need to provide your WCC file number, the names and addresses of both the claimant and employer, details about the injury or illness, and the average weekly wage (AWW). Additionally, you must outline the facts in dispute, legal issues involved, and information about any witnesses or exhibits related to the case. Medical evidence and impairment ratings are also critical components. Thoroughness and accuracy are essential when completing these sections to avoid delays.

How do I submit the WCC Form 58?

Common mistakes

Filling out the WCC 58 form is crucial for those navigating the workers' compensation process in South Carolina. However, several common mistakes can complicate matters and delay proceedings. One frequent error is failing to include the WCC File Number, which is essential for the Workers’ Compensation Commission to track claims. Without this number, processing becomes difficult, leading to possible delays in receiving benefits.

Another mistake involves inaccuracies in the claimant's and employer's names and addresses. It's vital that all information is spelled correctly and accurately reflects the information on other related forms. Mistakes in this area can lead to miscommunication and potential disputes about who the claim pertains to.

Individuals sometimes overlook the details in the injury and the grounds for the claim. Section 3 of the form requests a description of the type of injury and affected body parts. Failing to provide clear and comprehensive information here can hinder the Commission's understanding of the case. Similarly, adequately summarizing the facts in controversy and the legal issues involved, as required in sections 4 and 5, is essential. Generic or vague descriptions can lead to misunderstandings about the claim's specifics.

When it comes to providing witnesses, some people forget to indicate if any are experts. Expert witnesses can greatly impact the outcome of a hearing. Therefore, their identification is crucial. Furthermore, including exhibits and medical evidence is often mishandled. The form needs exact references to reports or exams, and neglecting to list this information can weaken a case.

Moreover, the section concerning mediation often causes confusion. Those filling out the form must be clear about whether mediation is requested or has been conducted, indicating the proper regulations that apply. Misrepresentation in this part can lead to procedural problems down the road.

Another frequent issue arises from the proof of service section. Individuals sometimes forget to include crucial delivery information or do not indicate the method used to serve the required documents. This oversight can lead to disputes about whether the opposing party was adequately informed of the proceedings.

Finally, one cannot forget the importance of signing the form. A failure to provide a signature signifies that the individual does not verify the information or that they may not be fully committed to the claims process. This simple, yet critical step is often overlooked and can result in the refusal of the claim.

By avoiding these common mistakes, individuals can significantly improve their chances of a smooth and efficient workers' compensation claim process. Ensuring that details are accurate and complete helps facilitate better communication with the Workers’ Compensation Commission and can ultimately aid in a successful resolution of the claim.

Documents used along the form

When dealing with workers' compensation cases in South Carolina, the WCC 58 form, also known as the Pre-Hearing Brief, is often accompanied by several other essential documents. Each of these forms serves a specific purpose in the legal process, ensuring clarity and organization as the case progresses.

  • WCC Form 50/51: This document is the initial application for workers’ compensation benefits. It outlines the claimant's information, details about the injury, and the compensation being sought. It is critical for establishing the basis of the claim.
  • WCC Form 12: Known as the Mediation Request form, it is used to formally ask for mediation when disputes arise between the claimant and the employer. This form is necessary to move towards resolving issues without going to a full hearing.
  • WCC Form 17: This is the Request for Hearing form, which initiates the formal hearing process. It provides details about the parties involved and the issues that need to be resolved, allowing the commission to schedule a hearing.
  • WCC Form 26: The Notice of Appearance serves to inform the commission and other parties of an attorney's representation. It is vital for ensuring that all communications regarding the case are directed to the appropriate legal counsel.

Each of these forms plays a significant role in the workers' compensation process. Staying organized and ensuring accurate completion of these documents can facilitate smoother communication and proceedings within the South Carolina Workers’ Compensation Commission.

Similar forms

  • Form 50: Notice of Claim - Like the WCC 58, this form initiates a workers' compensation claim. It details the claim information and establishes the basis for seeking benefits.
  • Form 51: Employee's Injury Claim - Similar to the WCC 58, this form outlines the specifics of an employee’s injury and the claim being made, including the nature of the injury and relevant dates.
  • Form 18: Notice of Intent to Injure - This document notifies the employer that an employee intends to file a claim for a work-related injury, paralleling the pre-hearing notice aspects of the WCC 58.
  • Form 27: Request for Hearing - Used to formally request a hearing, this form relates closely to the WCC 58, as both address matters requiring adjudication in workers' compensation cases.
  • Form 29: Mediation Request - This form serves a similar purpose regarding mediation, like the mediation sections in the WCC 58. Both documents facilitate dispute resolution prior to a hearing.
  • Form 30: Status Report - This document provides updates on the claim's status, akin to how the WCC 58 outlines the current state of a claim leading up to a hearing.
  • Form 31: Claimant's Facts - This form presents the factual background of a claim. Similar to the WCC 58, it focuses on the pertinent details related to the injury or illness.
  • Form 32: Employer's Report - This report captures the employer's account of the incident, mirroring the claim-related aspects in the WCC 58.
  • Form 40: Settlement Agreement - While this document centers around finalizing a settlement, it shares similarities with the WCC 58 in that both relate to the resolution of a workers' compensation claim.

Dos and Don'ts

Filling out the WCC 58 form is a crucial part of your workers' compensation claim process. Here are some essential dos and don’ts to help ensure that your form is completed correctly and efficiently.

  • Do provide accurate information. Double-check all details such as names, addresses, and dates to avoid any confusion.
  • Do clearly explain the grounds for your claim. Make sure to specify whether it’s due to an injury, illness, or repetitive trauma.
  • Do include all necessary supporting details. This means listing witnesses, exhibits, and any medical evidence relevant to your claim.
  • Do sign and date the form. Your signature verifies that the information is true and complete to the best of your knowledge.
  • Do keep a copy for your records. Having retain records of what you submitted can be very helpful.
  • Don’t leave sections blank. Fill out every part of the form to the best of your ability; incomplete forms may cause delays.
  • Don’t send unnecessary documents. Avoid sending medical reports unless specifically requested.
  • Don’t forget to verify the proof of service. Make sure you follow the required steps to show that you have served the document to the opposing party.
  • Don’t wait until the last minute. Allow yourself enough time to gather information and make sure everything is correct before submission.
  • Don’t ignore the deadlines. Be aware of any timelines for filing to keep your claim on track.

Misconceptions

Understanding the WCC 58 form can be challenging. It's important to address common misconceptions surrounding it. Here are seven prevalent misunderstandings, along with clarifications.

  • Misconception 1: The WCC 58 form is only for serious injuries.
  • This form can be used for a variety of claims, including illnesses and repetitive trauma, not just serious injuries. Whether your claim is for a minor injury or an ongoing health issue, the WCC 58 is applicable.

  • Misconception 2: I need an attorney to file this form.
  • While legal representation can be helpful, it is not a requirement. Many individuals choose to prepare and submit the WCC 58 form on their own, especially for straightforward cases.

  • Misconception 3: Filing the WCC 58 guarantees my claim will be approved.
  • Submitting this form is just one step in the workers’ compensation process. It does not guarantee approval but ensures that your case is formally documented and can be reviewed.

  • Misconception 4: The WCC 58 form is only submitted once.
  • Depending on your situation, you may need to amend or update your filing. If there are changes in your circumstances or new information emerges, you can revise the form accordingly.

  • Misconception 5: I must include all medical reports with the WCC 58 form.
  • You do not need to attach medical reports when filing this form. The instructions specify that only proof of service and the completed form should be submitted at that stage.

  • Misconception 6: The WCC will automatically assign a mediation session upon filing the WCC 58 form.
  • Mediation must be specifically requested in the form. Depending on the circumstances, a mediation session may be ordered, but this is not automatic.

  • Misconception 7: The date of hearing is immediately set upon submission of the WCC 58.
  • The date and time for a hearing are arranged after the form has been filed. This allows for the coordination of all parties involved in the case.

Clarifying these misconceptions can make the process less daunting. Always ensure you have the correct information and reach out for assistance if needed. You're not alone in this process.

Key takeaways

When it comes to the South Carolina Workers' Compensation Commission, the WCC 58 form is essential for properly presenting your case. Here are some key takeaways to consider when filling out and utilizing this form:

  • Identify the parties involved: Clearly fill in the names of the claimant and employer. This establishes who is involved in the case.
  • Provide accurate contact information: Include relevant addresses and phone numbers for both the claimant and the employer to facilitate communication.
  • Specify the injury type: Clearly indicate whether the claim is based on an injury, illness, or repetitive trauma, as this will frame the context of your claim.
  • Compensation details: Include information on compensation rates, average weekly wage (AWW), and the date of the injury.
  • Address facts in controversy: It’s important to outline any disputed facts related to the case to clarify issues that need resolution.
  • Identify legal issues: Specify any legal questions that arise in your case to help the reviewers understand the broader implications.
  • List witnesses: Mention any potential witnesses, including their status as experts, which may provide crucial testimony.
  • Include medical evidence: Reference any reports or depositions that support the claim. Ensure these documents are not submitted with the WCC 58 form.
  • Mediation options: Indicate if mediation is requested and choose the appropriate regulatory basis for it.
  • Verify service of the document: Certification of service to the opposing party is critical. Specify how this was done and the date of service.

By paying attention to these key aspects, the WCC 58 form can be filled out effectively, thereby enhancing the chances of a favorable outcome in your workers' compensation case. Always remember to keep a copy for your records and ensure all information is accurate before submission.