I totaled a rental car many years ago--of course, it wa not my fault . It had been rented with a relative's Amex (I was an authorized driver on the rental although I did not, at the time, have insurance of my own).

Amex picked up all the costs without much hassle.

Ever since then I have used Amex when I rent a car.

I am happy to pay the $45 fee for a Starwood Amex even if I only used it for rentals. But, actually I use it a lot and consider the Starpoints also well worth the annual fee.