I never get the insurance since I am already paying for it with my personal auto policy. I have never had a claim in a rental car, so I can't speak to the process if there is an issue.
I did go round and round with a Hertz agent in HOuston about what would happen if there was an incident. He saying I could be required to come up with thousands at the end of the rental while the claim is settled. Me pointing out the Visa Signature Rules say you can't do that. Him saying they don't adhere to those rules. Me pointing out that Visa says....if you accept Visa Credit cards, you have already have agreed to that, and it includes a toll free number to call if a Visa merchant does not comply.