Employees Notice Of Claim And Or Request For Hearing - Death Case {52}

52 - CLAIMANT’S NOTICE OF CLAIM AND/OR REQUEST FOR HEARING, DEATH CASE. This form is utilized to formally notify the South Carolina Workers’ Compensation Commission regarding a fatality and/or to initiate a claim for workers’ compensation death benefits. It gathers essential information about the deceased employee, the claimant (who is typically a surviving spouse, minor child, dependent, or other eligible individual), and the circumstances surrounding the injury leading to the employee's death. Additionally, it allows for the identification of parties involved, details regarding the injury, notification of unpaid medical treatment, and other relevant factors pertinent to the claim. www.FormsWorkflow.com