Can the UIM selection be signed electronically?

Yes. Electronic signatures are enforceable under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided intent, consent, attribution, and permanent record retention are satisfied.

Do consumers need a separate disclosure?

If the transaction is consumer-facing, ESIGN requires a consumer disclosure about the right to paper and how to withdraw consent; include that disclosure before obtaining an electronic signature.

What happens if the form is incomplete?

Incomplete elections can delay coverage determinations and increase claim disputes; insurers should request completion promptly and document follow-up communications.

Is notarization required for the election?

Notarization is generally not required for UIM selections; verify specific state or policy requirements before notarizing to avoid unnecessary steps.

How can an insured change their election later?

Allow changes at renewal or pursuant to policy change provisions; record the new signed election and retain prior versions for audit and claims history.

Where should the signed form be stored?

Store the signed copy in the policy administration system and claims file; retain the audit trail and consider long-term archival in compliance with IRS, HIPAA, or state retention rules as applicable.

Electronic Signature
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Insurance
Insurance UIM Selection Form

Insurance UIM Selection Form

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Insurance UIM Selection Form

Applicant / Insured Information

Insured Name: Policy Number: Mailing Address:

Date of Birth:

Phone Number:

Email Address:

Driver's License / ID Number:

Policy Details

Insurer Name:

Policy Effective Date:

Policy Expiration Date:

Policy Type: Private Passenger Auto Commercial Auto Motorcycle Other

If Other, describe:

Underinsured Motorist (UIM) Coverage Selection

The undersigned elects the following Underinsured Motorist coverage selection for the policy identified above. Please mark applicable selection(s) and complete limits where required. Selections made below will form part of the insurance policy and will be effective for the policy period specified.

Elect UIM limits equal to the liability limits of this policy

Elect specified UIM limits of: Per Person $ Per Accident $

I decline Underinsured Motorist coverage for this policy If declining, please initial here:

Stacking Option: Stacked Non-Stacked Deductible (if applicable): $

Additional Instructions / Notes:

Exclusions and Limitations

UIM coverage does not apply to loss caused intentionally by the insured, punitive or exemplary damages unless specifically provided by endorsement, bodily injury arising out of the insured's use of a vehicle without the owner's permission, or as otherwise limited by the policy. This selection does not alter other policy terms, including subrogation, cooperation, or proof of loss requirements.

By signing this form the insured acknowledges that exclusions, limits, and terms contained in the policy will control the availability and extent of any recovery under UIM coverage and that the insurer may require proof of loss and cooperation in the handling of claims.

Beneficiary Designation

In the event sums payable under UIM are payable to a beneficiary or estate, designate the payee(s) below. The designation below is limited to payments arising from this policy and does not modify any other beneficiary arrangements under separate coverages.

Beneficiary 1 - Name:

Beneficiary 2 - Name:

Beneficiary 3 - Name:

Acknowledgement and Certification

I certify that I have read and understand the UIM coverage options and exclusions described herein. I understand that my selection or rejection will become part of the policy and that any change after issuance may require a signed amendment or endorsement. I further acknowledge that a declination of UIM may affect my ability to recover for certain economic and non-economic losses resulting from underinsured motorists.

I declare under penalty of perjury and subject to the terms of the policy that the information provided on this form is true and correct to the best of my knowledge. I authorize the insurer to rely on this selection until I provide written notice of change in accordance with policy provisions.

By signing below, I acknowledge receipt of a copy of this selection form.

Applicant Name:

Signature:

Date:

What the Insurance UIM Selection Form Is

The Insurance UIM Selection Form documents an insured party’s choice to accept, reject, or modify uninsured/underinsured motorist (UIM) coverage offered by an insurer. It records coverage limits, effective dates, and any optional endorsements required by statute or policy. Insurers typically use this form at new policy issuance, renewal, or when a coverage change is requested. The signed form becomes part of the insurance policy record and supports later claims or regulatory review of whether the insured received statutorily required notice and made an informed election.

Why completing an accurate UIM selection matters

A clear, signed UIM selection protects the insured’s rights under the policy, establishes the insurer’s compliance with state notice requirements, and reduces disputes in claims. Properly documented selection can affect recovery limits after an accident and helps avoid statutory penalties or coverage denials.

Who typically completes and reviews this form

The following parties are most commonly involved in completing or processing UIM selection forms.

Individual policyholders who must confirm their UIM choice for personal auto coverage.
Insurance agents or brokers completing elections on behalf of customers with authorization.
Company risk managers or commercial policy administrators for fleet and corporate accounts.

Accurate completion reduces disputes, accelerates claim handling, and clarifies coverage boundaries for all parties.

Step-by-step: completing the UIM selection form

Follow these steps in order to complete and validate a UIM election with minimal rework.

01

Review policy: Confirm current policy limits and declarations.
02

Choose option: Select the exact UIM election to be recorded.
03

Enter details: Complete name, policy number, date, and coverage selection.
04

Sign and retain: Obtain signature, record audit trail, and store the signed copy.

Customizing an online UIM selection workflow

Configure fields and authentication that match regulatory and organizational requirements when moving the form online.

Field	Configuration
Required fields	Policy number, insured name, selection date
Authentication	Email link or SMS code; KBA where required
Conditional logic	Show additional questions when 'Accept' is chosen
Retention settings	Save signed PDF and audit trail for required period

Where the completed form should go and how it’s routed

Define the submission and routing path to ensure the election is captured in policy administration systems and claims files.

To insurer policy file: Attach signed copy to the policy record
To agent record: Store in agent management system
To claims system: Route if a related claim is open
To regulatory archive: Retain if state law requires separate notice filing

Technical requirements for digital completion and eSubmission

Ensure the chosen platform supports required file types, authentication, and audit logging before deploying the form online.

Integrations: Salesforce, NetSuite, Google Workspace
File formats: PDF, DOCX accepted
Authentication: Email, SMS code, KBA options

Core components every professional UIM selection form should include

A well-designed form balances clarity for the insured with the insurer’s need for precise recordkeeping and regulatory compliance.

Clear election options

Present concise, mutually exclusive choices (accept, reject, modify) and list corresponding coverage limits so the insured understands consequences and comparisons.

Policy linkage

Include an explicit field for the insurer-assigned policy number and effective dates to ensure the selection attaches to the correct policy record and prevents administrative mismatches.

Notice language

Provide statutorily required disclosure language or insurer-specified explanation of UIM coverage and the right to decline to ensure informed consent and regulatory compliance.

Signature and date

Require a dated signature field and, for e-signatures, capture an audit trail with timestamp, IP, and authentication method to support enforceability.

Agent acknowledgement

Allow agent name, license number, and checkbox confirming that coverage options were explained, which helps resolve later disputes about disclosure.

Retention and distribution

Document where the signed form will be stored, how long it will be retained, and which departments or systems receive copies to ensure consistent recordkeeping.

Essential fields to include on the form

Insured name: Full legal name

Policy number: Exact policy identifier

Selection date: MM/DD/YYYY format

Coverage choice: Specific limit or 'Reject'

Signature: Signed and dated

Agent info: Agent name and license

Timing and common submission moments for UIM selections

Timing expectations depend on insurer workflow and state rules; these common moments help you plan when to provide or request the selection.

At new business:

Provide selection when policy is first issued

At renewal:

Confirm or change UIM option at each renewal

When coverage changes:

Submit selection whenever limits or vehicles change

On insurer request:

Respond within insurer-specified timeframe

When required by state:

Follow any state-mandated notice or election schedule

Common mistakes to avoid when preparing the form

Entering an abbreviated name or nickname that does not match the policyholder record causes processing delays and verification failures.
Selecting a vague coverage description instead of a specific limit creates ambiguity and increases claim dispute risk between insurer and insured.
Omitting agent information or license number removes a key evidentiary link when resolving later questions about disclosure or advice given.
Failing to preserve the audit trail for an electronic signature undermines the ability to demonstrate consent, attribution, and timing under ESIGN and state law.

Penalties and risks from incorrect or missing UIM selections

Coverage denial risk: Possible reduced recovery

Regulatory fines: State penalties for notice failures

Claim disputes: Increased litigation likelihood

Reinsurance impacts: Incorrect records affect reinsurance

Agent liability: Errors may trigger agent discipline

Recordkeeping exposure: Missing files complicate audits

eSignature vendor comparison for completing the UIM selection form

Cost and capability comparisons can inform platform selection; signNow is listed first in accordance with vendor ordering rules and verified plan details are shown where available.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by vendor	Varies	Varies	Varies
Bulk Send	Yes (Business Premium)	Varies	Varies	Varies	Varies
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies	Varies	Varies

Real-world examples of UIM selection handling

The following scenarios show how organizations manage elections and the downstream benefits of accurate forms.

Case Study 1

A mid-size insurer standardized a single UIM election template across states to ensure consistent notice.

They added conditional fields for state-specific disclosures.
Standardization reduced agent entry errors, accelerated audits, and made elections searchable in the policy admin system for quicker claim adjudication.

Case Study 2

A commercial fleet operator used bulk electronic distribution for vehicle-level UIM elections.

Fleet manager authorized a single representative.
Bulk processing and central retention cut administrative time and ensured consistent elections across hundreds of vehicles when coverage limits changed.

Who is authorized to sign the UIM selection

Named Insured — Policyholder

The named insured or an authorized signatory for a business may sign the selection form. Ensure the signer’s name matches the policy record; for businesses, include title and evidence of authority to bind the entity.

Authorized Representative — Agent or Broker

An agent or broker may complete the form with explicit insured authorization; include agent license number and a checkbox confirming the insured received statutorily required notice and explanation.

Practical tips for accurate, efficient completion

Adopt these practices to minimize disputes and administrative rework when collecting UIM elections.

Use clear, statutory notice language

Include the exact wording required by the applicable state statute when notifying insureds of the right to accept or reject UIM coverage to avoid regulatory challenges and ensure informed consent.

Validate policy identifiers automatically

Link the form to policy administration records and validate policy number and named insured fields in real time to prevent misfiling and reduce manual reconciliation.

Capture robust e-sign audit trails

When using electronic signatures, record IP, timestamp, authentication method, and consent to receive records electronically to meet ESIGN and UETA evidentiary standards.

Store signed copies with retention metadata

Index the signed form by policy number, effective date, and signer; include retention metadata to automate disposal according to organizational and legal retention rules.

FAQs and troubleshooting for the Insurance UIM Selection Form

Answers to common questions about validity, timing, signatures, and where to keep the signed selection form.

Need help? Contact support

Can the UIM selection be signed electronically?
Yes. Electronic signatures are enforceable under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided intent, consent, attribution, and permanent record retention are satisfied.
Do consumers need a separate disclosure?
If the transaction is consumer-facing, ESIGN requires a consumer disclosure about the right to paper and how to withdraw consent; include that disclosure before obtaining an electronic signature.
What happens if the form is incomplete?
Incomplete elections can delay coverage determinations and increase claim disputes; insurers should request completion promptly and document follow-up communications.
Is notarization required for the election?
Notarization is generally not required for UIM selections; verify specific state or policy requirements before notarizing to avoid unnecessary steps.
How can an insured change their election later?
Allow changes at renewal or pursuant to policy change provisions; record the new signed election and retain prior versions for audit and claims history.
Where should the signed form be stored?
Store the signed copy in the policy administration system and claims file; retain the audit trail and consider long-term archival in compliance with IRS, HIPAA, or state retention rules as applicable.

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