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…
A Building Management System (BMS) is the “brain” that monitors and controls key building services such as heating, ventilation and air conditioning (HVAC), lighting, power, access control, fire and life safety interfaces, lifts, water systems, and sometimes even energy storage and EV charging.
Modern BMS platforms are increasingly “smart” because they:
Pull data from many sensors and IoT devices
Automate responses (e.g., adjust ventilation based on occupancy)
Provide remote access for facilities teams and contractors
Integrate with cloud dashboards and analytics
Use alerts, trend analysis, and sometimes AI to predict faults
From an insurance viewpoint, that combination can be a major risk reducer (earlier detection, fewer losses) or a risk amplifier (more connectivity, more points of failure). The truth is usually: it can do both, depending on how it’s designed, secured, and maintained.
Commercial property insurers are focused on frequency and severity of claims. A smart building with a well-run BMS can reduce common causes of loss, including:
Escape of water (leaks, burst pipes)
Fire and smoke damage (early detection, controlled shutdowns)
Equipment breakdown (predictive maintenance)
Business interruption (faster response and restoration)
Liability exposures (better compliance and audit trails)
But insurers also worry about:
Cyber events leading to physical damage
Remote access vulnerabilities
Single points of failure (one system outage affecting multiple services)
Poor change control (updates that break critical controls)
Reliance on third parties (integrators, MSPs, cloud vendors)
If you’re a property owner, landlord, managing agent, or facilities manager, the goal is to show that your BMS is a risk control, not a risk concentration.
Smart sensors and continuous monitoring can spot issues before they become losses.
Examples:
Water leak sensors in plant rooms, risers, and under raised floors
Temperature monitoring to prevent frozen pipes
Differential pressure monitoring for HVAC filters and ducting
Alerts for abnormal power draw that may indicate overheating or failing components
For insurers, early detection often means smaller claims and less business interruption.
A modern BMS can trend performance and flag deterioration.
Chillers and boilers can be monitored for efficiency drift
Pumps and fans can be monitored for vibration or abnormal load
Duty/standby equipment can be rotated automatically
This can reduce equipment breakdown claims and can support better risk presentation at renewal because you can evidence maintenance discipline.
A BMS is not a replacement for a compliant fire alarm system, but it can support fire safety by:
Managing smoke control systems
Controlling fire dampers (where applicable)
Triggering safe shutdown sequences for HVAC
Supporting emergency lighting testing and reporting (in some setups)
Insurers like to see that life safety systems are properly segregated, tested, and not dependent on insecure remote access.
Energy efficiency isn’t just a cost issue. It can reduce risk by:
Avoiding overheating and electrical stress
Reducing load peaks that can contribute to failures
Highlighting abnormal consumption that may indicate faults
Some organisations also use BMS data to support ESG reporting. While ESG itself isn’t “insurance”, better governance and documentation can help your overall risk profile.
A well-managed BMS environment can produce:
Logs of alarms and responses
Records of setpoint changes
Proof of testing schedules and outcomes
That evidence can be valuable after an incident and can support claims defensibility.
The biggest modern shift is that cyber events can now cause physical outcomes.
Potential scenarios:
A threat actor gains access and disables alarms or monitoring
Ransomware locks out facilities teams from the BMS dashboard
Setpoints are maliciously changed, causing overheating, freezing, or humidity damage
Access control or lift systems are disrupted, creating safety and liability issues
This is why insurers increasingly ask about cyber controls even for “traditional” property risks.
Remote access is convenient for facilities teams and contractors, but it can introduce:
Weak passwords or shared credentials
Unpatched VPN appliances
Exposed remote desktop services
Poorly secured vendor portals
If remote access is required, it should be tightly controlled, monitored, and segmented.
Smart buildings often involve multiple layers:
Field devices (sensors, actuators)
Controllers
Supervisory servers
Cloud dashboards
Integrations with other systems
More complexity can mean:
More points of failure
Harder troubleshooting
Higher reliance on specialist contractors
From an insurance angle, complexity can increase downtime and therefore business interruption severity.
If the BMS becomes the central controller for many services, an outage can cascade.
Examples:
HVAC failure leading to business interruption (especially for labs, healthcare, data rooms)
Loss of environmental control causing stock spoilage
Disruption to access control causing security and theft exposures
Insurers will want to understand resilience: redundancy, fail-safe modes, and manual override capability.
BMS environments sometimes lag behind IT best practice because:
Systems are “always on” and downtime is difficult
Vendors restrict patching or require certified integrators
Legacy protocols and devices remain in service for years
Uncontrolled updates can also create issues if they break integrations or disable alarms.
The risk is not only cyber; it’s also operational.
If you’re presenting a smart building risk to insurers, expect questions around:
Cyber security: segmentation, MFA, patching, monitoring
Resilience: backups, redundancy, manual overrides
Maintenance: planned preventative maintenance (PPM), contractor competence
Water damage controls: leak detection, automatic shut-off, inspections
Fire safety: testing, separation of life safety systems, compliance
Third-party risk: vendor access controls, contracts, SLAs
Business continuity: how quickly you can restore building operations
The better you can evidence these, the more likely your BMS will be seen as a positive.
Keep BMS/OT (operational technology) separate from corporate IT networks.
Use firewalls between zones
Restrict inbound and outbound traffic to what is necessary
Avoid direct internet exposure for controllers
Segmentation reduces the chance that a phishing email on a corporate laptop becomes a building outage.
Unique user accounts (no shared logins)
Multi-factor authentication for remote access and admin functions
Role-based access (contractors should not have full admin rights)
This is often one of the simplest improvements with a big risk impact.
Third parties are common in BMS environments.
Best practice includes:
Time-bound access (only when needed)
Logging of all remote sessions
Contractual requirements for security standards
Clear responsibility for patching and incident response
You don’t need perfection, but you do need a process.
Maintain an asset inventory (what devices exist, where, and what versions)
Prioritise critical vulnerabilities
Schedule maintenance windows
Test updates in a staging environment where possible
If your BMS server is encrypted or fails, how do you restore?
Regular backups of configurations and databases
Offline or immutable backups n- Tested restoration procedures
Insurers increasingly want to see not just backups, but proof they can be restored.
A resilient smart building should be able to operate safely if the “smart” layer fails.
Manual override for critical plant
Local control loops that keep safe temperatures
Default safe states for valves and dampers n- Documented emergency procedures
Escape of water is one of the most common and costly commercial property claims.
Consider:
Leak detection in high-risk areas
Automatic shut-off valves
Alarm escalation procedures (who responds, within what timeframe)
Regular inspection of flexible hoses and connections
A BMS can be a strong tool here, but only if alarms are acted on quickly.
Sometimes, yes. But it’s rarely automatic.
A BMS can help you negotiate better terms if you can demonstrate:
Reduced loss history or near-miss prevention
Documented maintenance and monitoring
Strong cyber controls and segmentation
Resilience and business continuity planning
On the other hand, if the BMS is poorly managed, insurers may:
Apply cyber-related exclusions or endorsements
Increase deductibles for escape of water or equipment breakdown
Request additional risk information (delaying renewal)
The key is to present your smart building as well-governed.
Depending on your operations and building type, BMS can influence:
Commercial property insurance: fire, flood, escape of water, storm, malicious damage
Business interruption insurance: downtime from building services failure
Engineering / equipment breakdown: boilers, chillers, plant, electrical systems
Cyber insurance: network security, ransomware, incident response
Public and employers’ liability: safety incidents linked to building systems
Professional indemnity (for contractors/integrators): design, installation, and maintenance errors
If you own multiple sites, insurers may also consider aggregation risk (one vulnerability replicated across many buildings).
Here are realistic examples that show both sides of the risk.
**Leak detected early (good outcome):** A sensor identifies water under a plant room pipe. The BMS triggers an alert and shuts a valve. Damage is limited to a small area.
**Remote access compromised (bad outcome):** Credentials are reused across contractors. An attacker accesses the BMS, disables alarms, and changes heating setpoints. Pipes freeze overnight, leading to major escape of water.
**Update causes outage (bad outcome):** A software update breaks integration between BMS and ventilation controls. The building cannot maintain air quality, forcing temporary closure.
**Predictive maintenance prevents breakdown (good outcome):** Trend data shows a chiller drawing increasing power. Maintenance is scheduled before failure, avoiding downtime.
These scenarios show why insurers don’t just ask “Do you have a BMS?” They ask “How is it managed?”
If you want your BMS to be viewed as a positive, prepare a short “BMS risk pack” for renewal:
Overview of the BMS architecture and what it controls
Network diagram showing segmentation and remote access method
Access control policy (MFA, unique accounts, contractor access)
Patch and update process (including who is responsible)
Backup and restore evidence (dates, frequency, test results)
Maintenance schedule and contractor competence
Water leak detection and shut-off arrangements
Incident response and business continuity plan
This can speed up underwriting and reduce awkward last-minute questions.
A modern BMS can reduce insurance risk by improving monitoring, maintenance, and response times, especially for escape of water, equipment breakdown, and business interruption.
However, it can also increase risk if it introduces cyber vulnerabilities, creates single points of failure, or is poorly governed.
The deciding factor is not the technology itself, but the controls around it: segmentation, access management, patching, backups, resilience, and a clear operational process.
If you’re investing in smart building technology, treat cyber and operational resilience as part of the project from day one. It’s one of the best ways to protect your building, your tenants, and your insurance position.
Often, yes—if it’s supported by evidence of monitoring, maintenance, and strong security. A BMS without governance may be viewed as an added exposure.
Potentially. If a cyber incident leads to physical damage (for example, freezing, overheating, or disabling monitoring), it can create property and business interruption losses.
In many cases, yes. If your BMS is network-connected or remotely accessible, it should be considered within your cyber risk assessment and policy discussions.
For many commercial buildings, it’s a combination of escape of water and cyber-enabled disruption. Leak detection and secure remote access are high-impact controls.
A BMS helps reduce breakdown frequency, but it doesn’t eliminate mechanical or electrical failure. Engineering/equipment breakdown cover can still be important, especially for critical plant.
Share how your BMS is secured, maintained, backed up, and how you respond to alarms. The more you can evidence, the easier it is to position the risk positively.
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