Who must sign the form?

The named insured on the policy or an authorized representative must sign. For corporate policies, include the signer's printed name and title to show authority.

Is a notary required?

Not typically required for UM/UIM selection in Nebraska; follow the insurer's instructions. If a notary is requested, use a state-authorized notary or RON if permitted.

Can the form be e-signed?

Yes when the insurer accepts electronic signatures consistent with ESIGN and UETA; ensure audit trails and retention are preserved.

What if the insured changes limits later?

A new signed selection or policy endorsement documenting the change should be submitted and retained; changes usually take effect per policy endorsement terms.

What happens if the form is missing?

Insurer records may rely on default policy terms, which can create coverage uncertainty; reconstructing intent later can be more difficult.

How long should I keep the signed form?

Retain the signed selection with the policy file for at least three years after termination; retain longer if tax, HIPAA, or state rules require extended retention.

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Nebraska Uninsured/Underinsured Motorists Coverage Selection of Limits

Nebraska Uninsured/Underinsured Motorists Coverage Selection of Limits

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

What this Nebraska Uninsured/Underinsured Motorists Coverage Selection of Limits form is

The Nebraska Uninsured/Underinsured Motorists Coverage Selection of Limits is a signed written selection or rejection used to document an insured's chosen UM/UIM coverage limits for an automobile insurance policy in Nebraska. It records the dollar limits selected or the insured's signed rejection of optional coverage, and it becomes part of the insurance contract. Insurers typically require this form at new business, renewal, or when the insured requests a change; accurate completion ensures the chosen limits are enforceable under the policy terms and state law.

Why a clear UM/UIM limits selection matters

Selecting or rejecting UM/UIM limits in writing provides legal clarity about your protection and reduces coverage disputes after a collision. The form documents consent or waiver, which insurers use to confirm coverage and to meet Nebraska regulatory expectations.

Who completes the Nebraska UM/UIM limits selection

Typical parties fill this form when a policy is issued, renewed, or changed; it documents the insured's affirmative choice about uninsured and underinsured motorist limits.

Individual policyholders who own or regularly drive insured vehicles.
Business entity owners listing corporate autos on a commercial policy.
Insurance agents or company representatives facilitating the insured's written selection.

Accurate completion protects both the insured and insurer by creating a clear contractual record of the elected limits or a documented rejection of optional coverage.

Step-by-step: completing the Nebraska UM/UIM selection

Follow these sequential steps to complete the selection clearly and avoid errors.

01

Identify Parties: Enter insured name exactly as on policy; matches ID and policy records.
02

Choose Limits: Select UM and UIM dollar limits for each vehicle or reject in writing.
03

Sign and Date: Signed by named insured; use MM/DD/YYYY format for dates.
04

Return to Insurer: Submit via insurer's instructions or retained as part of policy file.

How to set up the form for electronic completion

Configure fields and signer roles for e-submission so the form is captured and retained correctly.

Field	Configuration
Insured Name	Required text field; autocomplete from policy data
Policy Number	Required text field; validation for policy format
UM/UIM Limits	Dropdown options or radio buttons for standard limits
Signature	Signature field with date stamp and audit trail enabled

Where to send the completed Nebraska UM/UIM selection

Document routing varies by insurer; choose the channel that produces a retained record and confirmation of receipt.

Insurer Portal: Upload via the insurer's secure document portal for immediate attachment to the policy file.
Agent Email: Send to the agent's office email if the agent is authorized to receive submissions.
In-Person Delivery: Deliver signed paper to the insurer or agent, obtain a date-stamped receipt.
Electronic Signing Service: Use an eSignature provider that captures an audit trail and stores a signed copy.

Digital signing and e-submission considerations

Ensure the electronic workflow meets legal and insurer requirements for signature validity and record retention.

Authentication: Email or SMS code verification
Audit Trail: Time, IP, and signer attribution
Document Format: Final PDF with embedded audit data

Retain a signed copy with its audit trail in the insurer's records and the insured's files to support future coverage questions.

Timing and common deadlines to keep in mind

Be aware of policy and administrative deadlines that affect when a limits selection takes effect or is processed.

New Policy Effective Date:

Selection provided before or on effective date attaches to policy.

Renewal Deadline:

Insurer may require selection before renewal to apply new limits.

Change Requests:

Requested mid-term changes take effect per insurer rules and endorsement.

Claims-Time Review:

Signed selection helps resolve coverage at the claims stage.

Record Retention:

Keep the signed selection for the applicable retention period.

Key processing milestones after submission

A typical sequence shows where the selection is reviewed, attached, and relied upon for coverage determinations.

01

Submission Received

Document accepted by insurer or agent and logged into the policy system.

02

Underwriting Review

Underwriting confirms limits and ensures selection matches policy rules.

03

Endorsement Issued

Insurer issues an endorsement reflecting the selected limits when required.

04

File Retention

Signed form stored in policy records and accessible for claims.

Common mistakes to avoid when completing the form

Using abbreviations or nicknames instead of the insured's legal name, which can cause mismatched records and processing delays.
Failing to sign or date the selection, leaving the insurer without documented consent or rejection of coverage.
Selecting ambiguous limits (for example, writing 'maximum available') rather than a specific dollar amount or standard bracket.
Submitting the form to the wrong contact or lacking confirmation of receipt, which risks the selection not being applied.

Risks and consequences of incorrect or missing selections

Coverage Uncertainty: Claims may face disputes over whether UM/UIM was elected.

Delayed Claims: Insurer review may postpone claim payments pending confirmation.

Administrative Denial: Policy may be administered with default limits or rejection.

Tax/Legal Notices: Incorrect records can complicate subrogation or legal recovery.

Financial Exposure: Insured may lack intended protection against uninsured drivers.

Recordkeeping Gaps: Missing signed selection weakens insurer defense in disputes.

eSignature vendor pricing and capability snapshot for form completion

Comparison of common vendor starting prices and core capabilities relevant to completing and retaining UM/UIM selections. signNow is listed first per table convention.

	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 trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Essential elements to include on a professional UM/UIM selection form

A complete form contains several standardized elements so that insurers and courts can reliably interpret the insured's intent and selected protection.

Insured Identity

Full legal name and policy number to clearly attach the selection to the correct insured and policy period.

Vehicle Details

VIN, year, make, and model if selections are vehicle-specific rather than policy-wide.

UM Limits

Specific per-person and per-accident limits or an explicit rejection checkbox with signer initials where required.

UIM Limits

Clearly stated UIM amounts and whether they stack or apply per-vehicle when policy language permits.

Signature Block

Named insured or authorized representative signature, printed name, title if corporate, and date in MM/DD/YYYY format.

Agent/Insurer Notes

Space for agent acknowledgment, company file stamp, or endorsement reference linking to the policy record.

Frequently asked questions about the Nebraska UM/UIM limits selection

Answers to common questions about completing, signing, and storing the Nebraska Uninsured/Underinsured Motorists Coverage Selection of Limits.

Need help? Contact support

Who must sign the form?
The named insured on the policy or an authorized representative must sign. For corporate policies, include the signer's printed name and title to show authority.
Is a notary required?
Not typically required for UM/UIM selection in Nebraska; follow the insurer's instructions. If a notary is requested, use a state-authorized notary or RON if permitted.
Can the form be e-signed?
Yes when the insurer accepts electronic signatures consistent with ESIGN and UETA; ensure audit trails and retention are preserved.
What if the insured changes limits later?
A new signed selection or policy endorsement documenting the change should be submitted and retained; changes usually take effect per policy endorsement terms.
What happens if the form is missing?
Insurer records may rely on default policy terms, which can create coverage uncertainty; reconstructing intent later can be more difficult.
How long should I keep the signed form?
Retain the signed selection with the policy file for at least three years after termination; retain longer if tax, HIPAA, or state rules require extended retention.

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