Current through Register Vol. 48, 12, December 27, 2024
A.
Appearances at Informal Conferences.
(1) A
claims mediator may appear on behalf of a Commissioner at an informal
conference when the purpose of the informal conference is to:
(a) review a proposed Form 16 or Form 16A
settlement when the total amount of medical benefits paid is below the
threshold amount established by the Commission; or
(b) certify a Form 17.
(2) A Commissioner shall preside over an
informal conference when the purpose of the informal conference is to:
(a) approve a settlement in the form of a
full and final Agreement and Release made pursuant to Section
42-9-390;
or
(b) approve a proposed Form 16
or Form 16A settlement when the total amount of medical benefits paid meets or
exceeds the threshold amount as established by the Commission.
The Commissioner may, in the Commissioner's discretion, preside
over an informal conference that does not fall under items (a) or
(b).
(3) An
insurance adjuster licensed by the South Carolina Department of Insurance in
accordance with Chapter 47 of Title 38, South Carolina Code of Laws, may appear
on behalf of an employer or insurance company at an informal conference when
the purpose of the informal conference is to:
(a) review a proposed Form 16 or Form 16A
settlement when the total amount of medical benefits paid is below the
threshold amount as established by the Commission; or
(b) certify a form 17.
(4) An attorney licensed in this State or
admitted in accordance with R.67-1201C
shall appear on behalf of an employer or insurance company at an informal
conference when the purpose of the informal conference is to:
(a) approve a settlement in the form of a
full and final Agreement and Release made pursuant to Section
42-9-390;
or
(b) approve a proposed Form 16
or Form 16A settlement when the total amount of medical benefits paid meets or
exceeds the threshold amount as established by the Commission;
The Commissioner may deem it prudent for an attorney to appear
at an informal conference that does not fall under subsections (a) or (b)
according to the Commissioner's
discretion.
B. An informal conference is defined in
R.67-202(8).
C. Requesting an Informal Conference.
(1) A party requesting an informal conference
shall (a) write the Commission's Judicial Department requesting that an
informal conference be set, and (b) upload an updated Form 18 or the EDI
equivalent Sub Annual (SA) Periodic Report showing the status of payment of
temporary compensation, if any, and medical expenses.
(2) Upon receipt of a request for an informal
conference the Commission shall review the Commission's file for required
reports. The employer's representative must ensure that the following reports
are in the Commission's file before the informal conference is held, or the
employer's representative may be subject to a fine.
(a) Form 14B, if applicable; and
(b) Form 15, if applicable; and
(c) Form 17, if applicable; and
(d) Form 20, if applicable; and
(e) All medical reports required by
R.67-1301;
and
(f) An authorized health care
provider's report stating the claimant has reached maximum medical improvement
and an impairment rating, if any; and
(g) An amputation chart, if
applicable.
D.
The claimant may request an informal conference by writing the Commission's
Judicial Department and stating whether the parties propose to settle the claim
on a Form 16, a Form 16A, or by Agreement and Final Release.
E. An informal conference may be held with
less than thirty days' notice to the parties. The conference shall be held at a
hearing site as designated by the jurisdictional commissioner. If the parties
request in writing to convene the conference at a different hearing site, all
parties agree, and the request is received before the hearing notice for the
conference is issued, the request may be approved administratively.
F. Only a Commissioner is authorized to
approve a Form 16, a Form 16A, or an Agreement and Final Release.
G. When the claimant fails to appear at an
informal conference, the Commission shall reschedule the conference.
(1) If the claimant fails to appear twice,
the claim shall be removed from the informal conference roster and
administratively dismissed.
(2) The
claimant may request the Commission to schedule another informal conference and
the Commissioner assigned to the claim may, if a good cause is shown, allow the
claimant to proceed with his or her claim.
H. If the employer's representative or an
attorney, if any, fails to appear at the informal conference, the Commission
shall reschedule the conference. The Commissioner assigned to the claim may
assess against the employer's representative or an attorney, if any, the actual
costs of the conference as established by the Commission.
I. If the parties fail to reach an agreement
at the informal conference, or the proposed Agreement and Final Release is not
approved, the Commission shall set the claim on the contested case hearing
docket. A Form 50 or Form 52 is not required, but if filed, the opposing party
must respond pursuant to R.67-603.
J. Either party may request postponement of
the informal conference by writing either the Commissioner whose name appears
on the informal conference notice or the Judicial Department. The Commissioner
may reschedule the conference during the term the Commissioner is in the
district. If the Commissioner cannot reschedule the conference during his or
her term in the district, the Commission must reschedule the conference, unless
otherwise agreed to by the parties or ordered by the Commission.
