Best advice is check with your cc company for coverage info as your car insurance probably does not cover you in SXM.
From Canada, my Visa and Am EX will cover the collision but not the liability, so we buy the liability. I have found the liability cost varies car rental co to co. I suggest you check on the liability deductable as one rental co's quote may be lower, but the deductible higher.
Note – some cars offshore NA may not be covered by your cc, if you want to rent the bimmer on island, check 1st!
Short version, check for coverage and understand what you are paying for.
Overheard a conversation by the pool last winter at SXM, person was very putout that the car rental co pushed him hard to pay liability - he told them NO - his card of course covered him etc etc - did not have the heart to break into his rant and suggest otherwise
J&B