I've used CSATravel with good results. Once I had cancel a trip twenty days before departure because of neck surgery. CSA paid every dime in full. If you are paying close to 3k for a trip with airfare, $180 in insurance is worth it for me.
I'm thinking the others who posted in this thread have never had to collect on trip insurance because for me it was not a hassle to get my money (and my wife's BTW) back at all. I provided them with a letter from my Dr., they wrote me a check. If you want hurricane coverage, that's a separate rider, but it doesn't add much - when we go in hurricane season I always get that option. You can usually find trips on liveaboards much cheaper in hurricane season and the boats are empty, even adding the cost of the insurance is usually cheaper than full price.
Anyway, that's my real-life experience with it and I'm a believer.