interesting info, themicah!
My experience is from 9 years ago, so things may have changed. Hertz rental in California paid for with an AA card. I was the cause of the wreck (first and only time in my life) and it was a total loss for my rental and for the other vehicle. My insurance, Geico, covered the loss of the vehicle I hit I believe ~8k. The card insurance covered Hertz' loss up to $10k, and I believe the total was around $10,400. I called Hertz on a few occasions and no one could ever help me with making a payment on the balance, so I never did. For awhile I wondered if that was gonna go to collections, but it doesn't seem to have ever done so and my credit has always been excellent.
Hertz gave me a replacement the next morning (accident occurred late in the evening) but I had to go to a nearby location to pick it up (different from where I had originally picked up and was returning to). The replacement was actually an even nicer car. I do not recall how I got the car towed...may have been my roadside assistance, I am not sure. But I am pretty certain I did not pay out of pocket for it, or for anything through the whole ordeal. My insurance premiums went up slightly, but nothing out of the ordinary.