Bob1008, My AMEX Platinum card (to be clear, it's the one issued by AMEX that costs $450/year), gives this protection for free. You don't have to pay $19.95 per rental to get it; you simply have to reserve, and pay for the car, with your Platinum card.

From the platinum website:

Did someone hit your rental car? Not to worry, with the Car Rental Loss and Damage Insurance Plan.

Use Your Card
When you are the primary renter, simply use your eligible Card to reserve and pay for your auto rental.

Say "No Thanks"
Decline the collision damage waiver (CDW) or similar option when you are reserving and picking up your car from a Commercial Car Rental Company.

Enjoy the Ride
The Car Rental Loss and Damage Insurance Plan provides coverage up to $75,000 against theft of or damage to most rental vehicles. Coverage applies for the first 30 days, and is in excess to your other sources of insurance.

To find out more about this benefit, simply call 1-800-338-1670, toll-free. From outside of the U.S., call 440-914-2950 collect.

**

Photog72, I called American Express and asked your question. Here's what the rep said.

If you have personal coverage that would apply in the country you are traveling in, AMEX would be your secondary insurer. If you are traveling in a country that is not covered by your primary insurance, AMEX would then act as your primary insurer. However, the following countries are exceptions:

Australia, New Zealand, Italy, Jamaica, Israel, and Ireland.

So if you're traveling to one of these countries, I guess I'd sign up for their insurance.