U.K. and Ireland - Car Rental Insurance

I'm going to be renting a car in London for a trip through England, Wales and Scotland next month.

I'm covered by my Amex AeroplanPlus Gold card for CDW, but not medical or liability. I have health coverage, but my auto insurance policy does not cover rentals outside Canada/US.

So what to I have to buy at the rental counter for liability? What happens if I don't have it and there is an accident with a 3rd party liability issue? What traps do I need to watch for at the rental counter?

Would be grateful for any advice from those who have navigated these waters before me.

Check the rental T&Cs. Liability (3rd party) insurance is mandatory in the UK, and so may be included in the rates. However, some companies and booking sites allow customers from North America to book rentals without this insurance, but it's pretty inconsistent. If you don't have any such insurance, you'll be driving illegally.

As for medical, I'm not aware of any UK car hire companies that cover this, as we're covered by the NHS (although you do have to pay a contributory fee for motor accidents). However, I'm a local, so wouldn't be aware of such schemes anyway :)

You need to read the reservation quotes in great detail - they can vary.

As a generalisation, all the main companies in the UK include 3rd party cover (because it is a legal requirement) - but will leave you with an excess which is typically £800 on "normal" cars and upward of £1,000 on "premium" models.

UK companies are much more thorough on damage checks (every scrape matters) than you may be used to in North America....

You shoul get health insurance separately. The NHS will deal with any emergency (and deal with you immediately without any question or financial check) but once you are recovered they are likely to persue you for their costs.