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’re a facilities manager, you sit at the intersection of people, property, compliance, and business continuity. When something goes wrong—fire, flood, escape of water, storm damage, vandalism, a burst pipe at 2am—everyone looks to you for answers. Building insurance is one of the key safety nets that helps the organisation recover quickly, but it only works properly when the policy matches the building, the occupancy, and the real risks on site.
This guide breaks down what facilities managers must know about building insurance in practical terms: what it typically covers, where the gaps are, what information insurers need, and how to avoid common mistakes that can delay or reduce a claim.
Building insurance (often called “property damage” or “material damage” cover within a commercial combined policy) is designed to pay for repairing or rebuilding the physical structure after insured events.
Insurers usually treat the building as more than just bricks and mortar. It often includes:
The main structure: walls, floors, roofs, foundations
Permanent fixtures and fittings: built-in cupboards, fitted kitchens, sanitary ware
Services: fixed electrical wiring, fixed heating systems, lifts, air conditioning plant (if permanently installed)
Outbuildings: garages, storage units, plant rooms (if declared)
External property: fences, gates, signage, car parks, paths (often sub-limited)
Facilities managers get caught out when they assume “building insurance” covers everything on site. Common exclusions/grey areas include:
Contents (furniture, stock, portable equipment) – usually a separate section
Business interruption (loss of rent, loss of revenue, extra costs) – separate section
Wear and tear / gradual deterioration – not an insured event
Defective workmanship/design – often excluded (though resulting damage may be covered)
Unoccupied buildings – cover may be restricted unless agreed
Practical takeaway: your job is to ensure the policy definitions match what your organisation considers “the building” and “the assets,” and that nothing critical is sitting in a gap.
Most commercial building insurance is written on either a “specified perils” basis or “all risks” (often called “accidental damage” or “all risks of physical loss or damage” with exclusions).
Fire and smoke damage
Lightning
Explosion
Storm (wind, rain, hail)
Flood (often defined separately; may require specific underwriting)
Escape of water (burst pipes, leaking tanks)
Impact (vehicles, falling trees)
Theft (usually following forcible/violent entry)
Malicious damage / vandalism
Subsidence, heave, landslip (often optional or restricted)
All-risks wordings can be broader, but they are not “everything is covered.” They typically cover sudden, unforeseen physical loss or damage, subject to exclusions. This can be valuable for facilities managers because many real-world incidents don’t fit neatly into a named peril.
Practical takeaway: if your sites are complex (multiple tenants, mixed use, high footfall, frequent contractor activity), accidental damage can be worth serious consideration.
Underinsurance is one of the most expensive mistakes in building insurance. If the sum insured is too low, insurers can apply “average,” reducing the claim payment proportionally.
Facilities managers should focus on reinstatement cost (the cost to rebuild/repair to the same standard), not the market value of the property.
Reinstatement cost may include:
Demolition and site clearance
Professional fees (architects, surveyors, engineers)
Compliance upgrades required by building regulations
Inflation in labour and materials
Many policies are index-linked to help keep sums insured aligned with inflation. Index linking is helpful, but it’s not a substitute for periodic professional valuations.
Commission a reinstatement cost assessment (RCA) on a sensible cycle (often every 3–5 years, or after major works)
Track major changes: extensions, refurbishments, plant upgrades, roof replacements
Make sure professional fees and debris removal are included (or added as separate allowances)
Practical takeaway: treat the sum insured as a compliance-critical figure, not an admin detail.
Even well-written policies have exclusions and conditions. The goal isn’t to eliminate them—it’s to understand them and operate within them.
Insurance isn’t a maintenance contract. Gradual deterioration, corrosion, rot, and poor upkeep are usually excluded. However, resulting damage from a sudden event may still be covered.
Escape of water claims are among the most common and most disputed. Policies may include:
Higher excesses
Requirements for regular inspection of plumbing
Exclusions for damage from slowly leaking pipes
Facilities best practice:
Document inspections
Keep records of repairs
Install leak detection where feasible
If a building is unoccupied beyond a set period (often 30 days), cover may reduce or conditions may apply (draining down water systems, regular inspections, securing letterboxes, etc.).
Facilities best practice:
Maintain an occupancy log
Notify the broker/insurer early if a site will be vacant
Many serious losses come from hot works (welding, cutting, torch-on roofing). Insurers often expect:
Hot works permits
Fire watch procedures
Contractor competence checks
Clear housekeeping and combustible controls
Facilities best practice:
Keep permit-to-work records
Ensure contractors have their own insurance and RAMS
Subsidence cover can be restricted, expensive, or subject to high excesses. Claims can be slow and evidence-heavy.
Facilities best practice:
Monitor cracks and movement
Keep drainage maintained (blocked drains can contribute)
Practical takeaway: your operational controls (permits, inspections, logs) can be the difference between a smooth claim and a dispute.
Insurers price risk based on likelihood and severity. Facilities managers have direct influence over both.
Up-to-date fire risk assessments
Alarm and detection maintenance records
Sprinklers (where installed) maintained and tested
Fire doors, compartmentation, and housekeeping
Trace and access plans for isolation valves
Out-of-hours response plan
Leak detection and automatic shut-off (where viable)
Intruder alarms, CCTV, access control
Keyholder procedures
Perimeter lighting and physical security
A planned maintenance regime reduces the chance of “gradual” issues becoming major incidents. It also supports the narrative that the building is well managed—useful during underwriting and claims.
Practical takeaway: good facilities governance is a form of insurance optimisation.
Facilities managers often manage buildings where responsibility is split between landlord, managing agent, and tenants.
Key questions to clarify:
Who insures the building (landlord or tenant)?
Is the tenant responsible for internal fit-out? (and is it defined as fixtures or contents?)
Are there service charge provisions for insurance?
Are there subrogation waivers or contractual requirements?
Lease clauses relating to insurance and reinstatement
Schedule of dilapidations and responsibilities
Evidence of tenant alterations and approvals
Practical takeaway: claims can fail when responsibility is unclear. Facilities managers can reduce friction by keeping the paperwork organised and current.
When a loss occurs, speed and documentation matter.
Make safe: protect people first, then prevent further damage (e.g., isolate water, board up windows)
Notify: inform internal stakeholders and the insurer/broker promptly
Document: photos, videos, incident logs, contractor reports
Preserve evidence: don’t dispose of damaged items until agreed (where practical)
Policies typically require insureds to take reasonable steps to minimise loss. Facilities managers should:
Use approved contractors where required
Keep invoices and timesheets
Record decisions and timelines
Unclear cause of damage
Missing maintenance records
Disputes over what is “building” vs “contents”
Underinsurance and valuation issues
Practical takeaway: a claims-ready facilities team keeps templates, contacts, and evidence processes ready before anything happens.
Not all buildings are equal from an insurance perspective.
Reinstatement costs can be significantly higher
Specialist materials and trades may be required
Planning constraints can extend reinstatement timelines
Facilities best practice:
Ensure valuations reflect specialist rebuild requirements
Consider longer indemnity periods for business interruption (if applicable)
Buildings with flat roofs, timber frames, cladding systems, or unusual materials may face:
Higher premiums
More stringent risk requirements
Specific exclusions or higher excesses
Facilities best practice:
Maintain clear records of construction type and upgrades
Provide insurers with evidence of risk improvements
Practical takeaway: the more “non-standard” the building, the more important accurate disclosure becomes.
Many organisations buy building cover as part of a commercial combined policy, which can include:
Buildings
Contents
Stock
Business interruption
Employers’ liability and public liability
Money, goods in transit
Legal expenses
For facilities managers, combined policies can simplify administration, but they also mean one set of conditions can affect multiple sections.
Practical takeaway: read the policy schedule and key conditions as a whole, not just the “buildings” section.
Underwriters rely on accurate, current information. Facilities managers are often the best source.
Common underwriting questions:
Construction type, age, roof type and condition
Fire protections: alarms, sprinklers, compartmentation
Occupancy and use: manufacturing, office, retail, storage
Previous claims history and remedial actions
Security measures and out-of-hours procedures
Flood and subsidence exposure
Maintenance regimes and compliance checks
Practical takeaway: proactive, well-organised site information can improve terms and reduce back-and-forth at renewal.
Insurance works on “fair presentation of risk.” If material facts are missing or inaccurate, claims can be reduced or policies avoided.
Facilities managers should ensure changes are communicated, such as:
Change of occupancy (e.g., office to storage)
New tenants or sub-tenants
Building works, refurbishments, roof works
New plant or high-value equipment
Changes to fire protection systems (including impairments)
Facilities best practice:
Maintain a change log
Keep certificates, inspection reports, and maintenance records
Share key updates with the broker well before renewal
Practical takeaway: treat insurance disclosure like a living process, not a once-a-year form.
Use this as a quick reference.
Confirm what the policy defines as “buildings” and “contents”
Check the sum insured is a reinstatement figure (not market value)
Ensure professional fees and debris removal are included
Review excesses (especially escape of water, subsidence)
Confirm cover for unoccupied periods and required precautions
Validate contractor controls (hot works permits, RAMS, insurance)
Keep maintenance records accessible for claims
Maintain an incident response plan and key contacts list
Log material changes to the building and occupancy
Review valuations regularly and after major works
Building insurance is not just a finance line item—it’s a resilience tool. Facilities managers influence whether that tool works when it matters most. By understanding what’s covered, keeping sums insured accurate, managing risk on site, and maintaining strong records, you reduce the chance of disputes and help your organisation recover faster after an incident.
If you manage multiple sites or complex buildings, it’s worth reviewing your insurance structure and risk controls annually—before renewal pressure hits. A short, proactive review can prevent long, expensive problems later.
Usually not. Wear and tear and gradual deterioration are typically excluded. Insurance is designed for sudden, unforeseen events (like fire, storm damage, or a burst pipe).
Buildings are the permanent structure and fixed installations; contents are movable items like furniture, computers, and portable equipment. The exact split depends on policy definitions.
Average is an underinsurance clause. If your building is insured for less than its true reinstatement cost, the insurer may reduce the claim payment proportionally.
Yes. Material changes—especially building works, roof works, changes to occupancy, or changes to fire protection—should be disclosed promptly.
Many policies restrict cover after a set unoccupied period (often 30 days). You may need to follow additional security and inspection requirements and notify the insurer.
Often, yes—especially for complex sites with high footfall or frequent contractor activity. It can cover incidents that don’t fit neatly into named perils.
Strong risk management helps: documented maintenance, fire protection testing, leak detection, security controls, and robust contractor management can all improve insurer confidence.
Photos/videos, incident logs, maintenance records, contractor reports, and clear timelines. Evidence that you acted quickly to mitigate further damage is also important.
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