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…
Office refurbishments can be a smart way to increase asset value, attract better tenants, and future-proof a building. But they also create a very real risk: lost rental income. Whether you’re upgrading common areas, reconfiguring floors, replacing M&E systems, or carrying out a full strip-out, disruption can trigger rent abatements, tenant complaints, early lease exits, and extended void periods.
For UK landlords, property managers, and commercial investors, the goal is simple: complete the works safely and on time while keeping cashflow stable. That means planning the project like a business continuity exercise—aligning the scope, programme, lease terms, tenant communications, and insurance.
This guide breaks down practical steps to protect rental income during office refurbishments, including how to reduce downtime, manage tenant expectations, and structure insurance so you’re not left exposed if something goes wrong.
Before you choose finishes or appoint contractors, identify where rental income is most vulnerable. A quick risk map helps you prioritise controls.
Key questions:
Which tenants are most disruption-sensitive? (call centres, regulated financial services, healthcare, data-heavy operations)
What income is concentrated? (single anchor tenant vs multiple smaller occupiers)
What parts of the building are revenue-critical? (lifts, HVAC, toilets, reception, access control)
What are the “noisy/dirty” phases? (demolition, drilling, asbestos removal, riser works)
What are the programme pinch points? (lead times for plant, switchovers, approvals)
Output: a simple table of risks, likelihood, impact, and mitigation. This becomes the backbone for your refurbishment strategy and your insurance conversation.
Your biggest rental income decision is whether to refurbish with tenants in situ or to obtain vacant possession.
Pros:
Rent continues (at least partially)
Lower void risk
Easier to demonstrate ongoing building performance
Cons:
Higher risk of complaints and rent concessions
More complex logistics and safety controls
Programme can stretch due to restricted working hours
Best for:
Common area upgrades
Floor-by-floor works where access can be isolated
Projects with strong tenant relationships and flexible leases
Pros:
Faster programme, fewer constraints
Lower risk of tenant disruption claims
Easier contractor access and sequencing
Cons:
Immediate income loss during works
Re-letting risk if market conditions change
Best for:
Major M&E replacements
Structural alterations
Full repositioning projects
A hybrid approach is often the sweet spot: retain stable tenants on unaffected floors while refurbishing others, using a clear phasing plan and temporary services.
Rental income is usually lost through time, not just damage. A refurbishment that runs 8 weeks late can be more expensive than a single insured incident.
To reduce delay risk:
Appoint a competent principal contractor with proven office refurbishment experience.
Build realistic lead times for plant, switchgear, lifts, glazing, and specialist finishes.
Confirm statutory requirements early (fire strategy, building control, landlord consents, planning where needed).
Plan for surveys: asbestos, intrusive M&E, structural, fire stopping, compartmentation.
Include float for commissioning and snagging—handover delays often come from testing.
Commercial tip: treat critical path items as “income-protection items”. If a component could stop reoccupation, it deserves extra attention, alternative suppliers, or early procurement.
Your lease terms can either protect income or create a pathway for rent reduction.
Look for:
Quiet enjoyment obligations and how they’re interpreted
Landlord rights of entry and notice requirements n- Service charge provisions (what can be recovered)
Rent suspension clauses (often triggered by damage or inability to occupy)
Alterations and reinstatement obligations
If you have upcoming lease renewals or new lettings, consider negotiating refurbishment-friendly provisions:
Clear landlord access rights
Defined “permitted works” windows
Agreed noise/dust thresholds and working hours
Specific triggers for rent suspension (avoid vague wording)
For existing tenants, a short-form side letter can help:
Confirm the scope and timetable
Agree access arrangements
Set out temporary facilities (toilets, lifts, routes)
Define how complaints will be handled
Clarify whether any rent concession is offered (and under what conditions)
The goal is to prevent disputes that lead to rent withholding.
Tenants rarely object to improvement; they object to surprises.
A simple communication plan can protect income by reducing churn and concessions.
What to do:
Issue a refurbishment notice pack: scope, phases, dates, working hours, contact points.
Hold a tenant briefing (even 20 minutes) before each major phase.
Provide weekly updates with what’s changing and what’s staying the same.
Offer a “disruption hotline” (single email/phone) so issues don’t escalate.
Document everything—it matters if a dispute arises.
If you can show you acted reasonably and proactively, you’re in a much stronger position when tenants request abatements.
Many rent suspensions start with a preventable incident: a water leak, a small fire, a power outage, or dust ingress that makes a suite unusable.
Practical controls that protect income:
Isolate services properly (water, electrics, sprinklers) with clear permit-to-work.
Protect occupied areas with hoardings, negative pressure where needed, and dust control.
Maintain fire safety: temporary alarms, clear escape routes, fire stopping, hot works controls.
Plan noisy works out of hours where feasible.
Secure access: refurb projects can increase theft and unauthorised entry risk.
A well-managed site reduces the chance of a “small incident” becoming a multi-tenant business interruption event.
Insurance is often the last thing discussed—and that’s exactly why income protection fails.
Depending on the project and your existing arrangements, you may need a combination of:
Contract works / contractors’ all risks (CAR): covers damage to the works during the project.
Public liability: injury or property damage to third parties.
Employers’ liability: required for employers.
Property owners insurance: covers the existing structure (and sometimes loss of rent following insured damage).
Loss of rent / rent guarantee extensions: can respond when insured damage makes premises unlettable.
Business interruption (for landlords): sometimes structured as loss of rent or alternative accommodation costs.
The right setup depends on who is responsible under the building contract and leases.
Assuming the contractor’s policy covers your loss of rent: it often doesn’t.
Under-insuring the declared value: can reduce claims payments.
Incorrect “interest” noted: landlord, freeholder, managing agent, fund, etc.
Exclusions for defective workmanship: may cover resulting damage but not the defect itself.
Unoccupied building terms: if you go vacant, your property policy conditions may change.
If your refurbishment increases the building sum insured or changes occupancy, tell your broker early. A mid-project change can create coverage disputes.
Insurance is one layer; contracts are another.
To protect rental income, consider:
Liquidated and ascertained damages (LADs) for late completion where appropriate.
Clear responsibility for temporary services (power, water, HVAC) during works.
Defined working hours and access to reduce programme slippage.
Requirements for method statements and risk assessments that protect occupied areas.
Also ensure the contractor’s subcontractors are controlled. Many delays and incidents come from poorly managed specialist trades.
Even if you keep tenants during works, refurbishments can trigger “shopping around”. Protecting income means protecting occupancy.
Retention tactics:
Offer early renewal incentives tied to the improved specification.
Provide temporary amenities (meeting rooms, shared breakout space) if you’re disrupting theirs.
Share before/after visuals and a clear timeline so tenants see the value.
Consider short-term rent-free periods strategically rather than reactive concessions.
For re-letting:
Start marketing before completion.
Prepare spec sheets: EPC, HVAC capacity, floor loading, fibre, security, parking.
Use the refurb story as a positioning tool: “better air quality, modern reception, improved sustainability”.
Refurbishments rarely go exactly to plan. A cashflow buffer protects you from being forced into poor decisions.
Consider:
A contingency budget (often 10–15% depending on building condition)
A programme contingency for commissioning and approvals
A tenant contingency for temporary relocations or facilities
If you’re financing the project, align drawdowns with realistic milestones and avoid relying on “perfect timing” for reoccupation.
Disputes can lead to withheld rent, legal costs, and reputational damage.
Before works:
Do a schedule of condition for common areas and any occupied suites affected.
Photograph and record existing defects.
Confirm baseline performance for services (temperature, ventilation, noise).
During works:
Keep a log of incidents, complaints, and resolutions.
Record access notices and tenant acknowledgements.
After works:
Provide handover packs and commissioning certificates.
Close out snags quickly—unfinished details can delay reoccupation and rent start dates.
Use this as a quick pre-start list.
Confirm refurbishment strategy (phased vs vacant vs hybrid)
Review lease clauses (rent suspension, access, quiet enjoyment)
Issue tenant communication plan and named contacts
Complete surveys (asbestos, M&E, structural, fire)
Lock programme and critical path procurement
Confirm site controls (dust, noise, fire safety, access)
Align building insurance and contract works insurance
Confirm unoccupied property conditions if applicable
Build contractual protections (LADs, responsibilities, method statements)
Plan retention and marketing early
Protecting rental income during office refurbishments is less about luck and more about control. The landlords who keep cashflow stable are the ones who plan the programme around occupancy, communicate clearly, and structure contracts and insurance to match the real risks.
If you’re planning an office refurbishment, it’s worth speaking to a specialist commercial insurance broker early—before contracts are signed—so your property owners cover, contract works, and loss of rent exposure are aligned. That way, if the unexpected happens, you’re not relying on assumptions.
It depends on the lease. Some leases include rent suspension clauses if the premises are damaged by an insured risk and cannot be occupied. Disruption alone doesn’t always trigger rent suspension, but disputes can arise if access or essential services are affected.
Loss of rent cover (often part of property owners insurance) can help replace rental income if insured damage makes the premises unlettable. It usually responds only when there is physical damage caused by an insured peril.
Not usually. Contractors’ all risks typically covers damage to the works and sometimes existing structures, but landlord rental income is often covered under a separate loss of rent section on the property owners policy.
Focus on critical path items, confirm lead times early, complete surveys, and build float for commissioning. Also ensure access and working hours are realistic for the scope.
It can protect income, but it increases complexity. A phased approach can work well if you can isolate works, maintain services, and communicate clearly.
Tell them about the scope, value, duration, contractor details, changes to occupancy, and any periods of unoccupancy. This helps ensure your policy conditions and sums insured remain correct.
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