Medical Office Buildings: Unique Risks and Insurance Requirements
Why medical office buildings are different
Medical office buildings (MOBs) sit in a unique space between “standard commercial property” and “healthcare premises&rdquo…
If you own a commercial building and lease it to a tenant, insurance is one of the fastest ways a “simple” tenancy can turn into a costly dispute. The lease might say the tenant must reimburse your premium. The tenant might assume their own policy covers everything. Meanwhile, a burst pipe, fire, storm damage, or a liability claim can expose gaps between landlord and tenant responsibilities.
This guide breaks down the core insurance considerations for building owners in the UK: what cover you typically need, how insurance interacts with lease terms, what to watch for in service charge and rent schedules, and how to reduce the risk of underinsurance or uninsured losses.
Commercial leases vary, but most follow a familiar structure:
The building owner (landlord) insures the structure and any landlord-owned fixtures.
The tenant insures their contents, stock, equipment, and often their own liability and business interruption.
The tenant reimburses the landlord for the building insurance premium, usually as an “insurance rent” or through the service charge.
Where it gets complicated is in the detail: what counts as “the building”, whether improvements are included, whether loss of rent is insured, and whether the tenant is required to maintain cover to a specific standard.
Full Repairing and Insuring (FRI) lease: The tenant takes on repairs and reimburses the landlord’s building insurance. The landlord still typically arranges the building policy.
Internal repairing lease: Landlord retains responsibility for structure/external elements; tenant covers internal repairs and their own property.
Multi-let buildings: Landlord insures the whole building; tenants pay their share via service charge.
A landlord’s buildings policy is designed to protect the structure and landlord-owned property. Key areas to consider:
Most commercial buildings policies can include cover for:
Fire, lightning, explosion
Storm and flood
Escape of water (burst pipes)
Impact (vehicles, falling trees)
Theft and malicious damage (often with conditions)
Subsidence (sometimes optional or restricted)
Accidental damage (optional)
The right mix depends on the building type, location, construction, and occupancy.
If someone is injured and you’re legally liable as the building owner (for example, due to a defect in a common area), property owner’s liability can respond. This is especially important for:
Multi-let premises
Shared access routes, car parks, stairwells
Older buildings or buildings with higher footfall
A major claim can stop the tenant trading and may make the premises unoccupiable. Landlords often insure:
Loss of rent (or “rent receivable”) for a defined indemnity period (commonly 12–36 months)
Alternative accommodation costs (more common in residential, but still relevant where lease terms require it)
Loss of rent is frequently a lease requirement because it supports the “rent suspension” clause (more on that below).
In some areas and for certain tenants (banks, national brands, city-centre locations), terrorism cover may be requested. In the UK this is often arranged through Pool Re backed solutions.
If the building has plant such as:
Lifts
Pressure systems
Air receivers
Boilers
You may need engineering inspection cover to help meet statutory inspection requirements and reduce downtime.
Underinsurance is one of the most common and expensive problems for building owners.
Buildings insurance should be based on reinstatement cost (the cost to rebuild, including demolition, debris removal, professional fees, and compliance with current building regulations), not the purchase price or market value.
Many policies apply “average” if the sum insured is too low. Example:
True reinstatement value: £1,000,000
Sum insured: £700,000 (30% underinsured)
Claim: £200,000
With average, the insurer may pay only 70% of the claim (e.g., £140,000), leaving you to fund the shortfall.
Get a professional rebuild valuation periodically (especially after refurbishments)
Include professional fees and demolition costs
Consider index-linking
Review sums insured at renewal, not just when you buy the building
Your insurance should be aligned with your lease wording. If not, you can end up with a policy that doesn’t support the lease mechanics.
Typically sets out:
What the landlord must insure (perils, risks, sums insured)
Whether the landlord must insure with a “reputable insurer”
Whether the tenant must be noted (or whether the policy must waive subrogation)
How the tenant reimburses the premium
Tip: If the lease requires “all risks” cover, confirm what that means in practice. Modern policies are “specified perils” with optional extensions. Make sure the policy meets the lease intent.
Often states that if the premises are damaged by an insured risk and become unfit for occupation, rent is suspended until reinstatement.
This is why loss of rent cover matters. Without it, you may lose income during repairs.
Sets out the landlord’s obligation to reinstate following damage, usually using insurance proceeds.
Check:
Any time limits
Whether reinstatement is conditional on insurance proceeds being sufficient
Whether the tenant can terminate if reinstatement takes too long
Tenants often fit out premises: partitions, flooring, kitchens, racking, specialist electrical work.
Clarify in the lease:
Are tenant improvements treated as part of the building?
Who insures them?
What happens at lease end?
A common approach is:
Landlord insures the original structure
Tenant insures their fit-out and contents
But in practice, some fit-out becomes “fixtures” and can blur the line.
If a fire starts due to tenant negligence, the landlord’s insurer might pay the claim then pursue the tenant (subrogation). Many commercial leases aim to prevent landlord/tenant litigation by requiring:
Waiver of subrogation against the tenant (where available)
Noting the tenant’s interest
This needs to be discussed with your broker/insurer because not all markets will agree to broad waivers.
If you own a building with multiple tenants, the insurance structure must handle:
Common parts (stairs, corridors, lobbies)
Shared services (fire alarms, lifts)
Different tenant risk profiles (e.g., office vs light industrial)
Your lease should clearly allow you to recover:
The building insurance premium
Insurance-related fees (valuation, broker fees where permitted)
Claims handling costs (where recoverable)
Tenants will expect transparency. Keep:
Policy schedule
Statement of premium
Sum insured and valuation basis
A tenant change can alter the building’s risk. For example:
A warehouse becomes a spray shop
A café installs deep fat fryers
A vacant unit increases arson and escape of water risk
Many policies require you to notify changes in occupancy or material alterations. Build a process to capture this.
Even though your policy is the landlord’s, your risk is affected by whether the tenant carries the right cover.
Tenants should have public liability for their operations and visitors. You may want:
A minimum limit (often £2m–£10m depending on premises)
Evidence of cover annually
If the tenant employs staff, employers’ liability is legally required in most cases.
Tenants should insure:
Contents and stock
Plant and machinery
Tools and portable equipment
If the tenant can’t trade after damage, business interruption helps them survive. While this is the tenant’s issue, it can affect your income and the stability of the tenancy.
If the tenant has invested heavily in fit-out, ensure it’s insured by the right party.
Here are typical real-world scenarios where landlord/tenant insurance responsibilities can clash.
A pipe bursts in a first-floor unit and water damages the unit below.
Landlord’s buildings policy may cover damage to the structure
Tenant’s contents policy covers stock and equipment
Liability may depend on negligence and maintenance responsibilities
Dispute trigger: Who pays the excess? Who pays for betterment (upgraded materials)?
A tenant’s process causes a fire.
Landlord’s policy may pay for reinstatement
Insurer may seek recovery from the tenant unless waiver of subrogation applies
Dispute trigger: Lease says tenant is protected from subrogation, but policy doesn’t include the waiver.
Storm damages the roof and water enters.
Buildings policy should respond if storm is covered
Maintenance issues can complicate claims if the roof was already in poor condition
Dispute trigger: Was it storm damage or wear and tear?
An empty unit is vandalised.
Some policies restrict cover during vacancy
You may need additional protections: inspections, draining down, security
Dispute trigger: Policy conditions weren’t met, claim is reduced or declined.
Commercial property policies often have:
Standard excesses (e.g., £250–£1,000)
Higher excesses for escape of water
Very high excesses for flood or subsidence
Your lease should address:
Whether the tenant pays the excess when damage arises from their demise
Whether excesses are recoverable through service charge
How claims are notified and managed
Good practice is to set expectations upfront and keep a simple claims process document for tenants.
Insurers price commercial buildings based on risk controls. A few practical measures often help:
Regular inspections (especially for vacant units)
Leak detection and stopcocks clearly labelled
Heating maintained to prevent frozen pipes
Electrical testing and maintenance
Fire risk assessment and compliance with fire safety duties
Security: locks, shutters, alarms, CCTV where appropriate
Clear contractor controls for hot works
Even if premiums don’t drop immediately, these steps reduce claim frequency and protect your rental income.
Use this as a renewal and lease-alignment checklist.
Confirm the lease insurance clause: perils, sums insured, who pays, and evidence requirements
Ensure buildings sum insured is reinstatement-based and up to date
Add loss of rent with a suitable indemnity period
Include property owner’s liability at an appropriate limit
Review vacancy conditions and your inspection routine
Clarify tenant improvements: who insures what
Consider terrorism cover where relevant
Confirm subrogation/waiver requirements and whether the policy supports them
Keep documentation ready for tenants: schedule, premium, and summary of cover
There’s no single legal rule that applies to every situation, but most commercial leases require the landlord to insure the building and allow the landlord to recover the premium from the tenant. If you have a mortgage, your lender will usually require buildings insurance.
Typically, the landlord arranges the buildings insurance. Tenants usually arrange their own contents and liability cover. If you want tenants to meet minimum standards (limits, insurer rating, specific extensions), set this out in the lease.
Insurance rent is the tenant’s contribution towards the landlord’s building insurance premium, often paid alongside rent or via service charge.
Often the tenant’s interest is noted, or the policy includes clauses that recognise the tenant’s position. The exact approach depends on the insurer and lease wording.
If the sum insured is too low, the policy may apply average and reduce claim payments. That can leave the landlord (and potentially the tenant, depending on lease wording) funding the shortfall.
It depends on the lease and what the fit-out includes. Many tenants insure their own improvements, but some leases treat certain fixtures as part of the building. Clarify this before the tenant starts work.
Yes, often you do. Tenant business interruption protects the tenant’s income; loss of rent protects the landlord’s rental income and supports rent suspension clauses.
Sometimes. It depends on the lease wording and the circumstances of the claim. Many landlords set out in the lease or service charge provisions when excesses are recoverable.
A change in trade can be a material change in risk. You should be told and may need to notify your insurer. Consider a lease clause requiring the tenant to inform you before changing use.
Commercial lease insurance isn’t just about buying a policy—it’s about aligning the policy with the lease and the reality of how the building is used. A well-structured buildings policy, clear lease clauses, and a simple annual review process can prevent disputes, protect your rental income, and keep both landlord and tenant on solid ground.
If you want, tell me what type of building you’re insuring (single let vs multi-let, office/retail/industrial, and whether there’s any tenant fit-out) and I’ll tailor this guide into a more niche, SEO-targeted version for your ideal audience.
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