Rejection of UM coverage or selection of lower limits of UM coverage in Louisiana shall be on a form prescribed by the Louisiana Commissioner of Insurance and shall be provided by the insurer and signed by the insured or his legal representative.
A UM rejection or selection of lower limits form is valid for the life of the policy and a new form is not required to be signed for a renewal, reinstatement or substitute policy. A new UM rejection or selection of lower limits form is only required if the amount of coverage changes. The form shall be conclusively presumed to be part of the policy whether or not attached.
A properly completed form creates a rebuttable presumption that the insured “knowingly” rejected coverage, selected lower limits or selected economic only. Compliance with the prescribed form involves six tasks as set forth by the Louisiana Supreme Court in Duncan v. USAA Ins. Co., 950 So.2d 544 (La. 2006):
1. Initialing the selection or rejection of coverage chosen;
2. If limits lower than the policy limits are chosen, then filling in the amount of coverage selected for each person and each accident (or for combined single limits);
3. printing the name of the named insured or legal representative;
4. signing the name of the named insured or legal representative;
5. filling in the policy number if the number exists at the time the form is completed; and
6. filling in the date.
In Gingles v. Dardenne, 4 So.3d 799 (La. 3/13/09), a UM rejection form which, on its face, complied with the six tasks enumerated in Duncan, yet failed to comply with Louisiana Bulletin LIRC 98-01 (requiring that the insurance company name, group name or logo must be placed at the lower left-hand corner of a UM rejection form), was still found to constitute a properly completed form sufficient to establish the statutory rebuttable presumption that the insured knowingly rejected UM coverage.