Happy Anniversary!

Today marks the 3rd anniversary of my refusal letter.  It’s amazing to me that it has been that long: I really had to think about it this morning to confirm the length of time, as I’d originally thought it had only been two years.

I continue to learn more about medical inadmissibility in Canada – it continues to impact real people, often in surprising cases.  I have been able to help several people through the gauntlet.  By far the most successful path through is to demonstrate that the actual medical treatment required falls below the excessive demand threshold – it’s surprising how often CIC medical officer’s just say “it’s expensive” and foist the burden of computing costs back onto the applicant.

As for me, well I’ve turned my eyes towards the citizenship process.  With the impending changes to the process I either must apply now (and face a 3 year wait to chat with a Citizenship Judge) or wait until sometime in 2018 to apply (and face a 2 year wait…)  Life continues to be interesting.

For those of you dealing with Canadian excessive demand medical inadmissibility I wish you the very best.  While I’m not nearly so active these days, I do continue to answer questions and leave this blog as a (hopefully useful) resource for those facing it.

I do hope to read one of these days that the Federal Court has struck down A38(c)(3).  Maybe because it violates the separation of powers between Federal and Provincial governments, maybe because it violates the various UN agreements to which Canada is signatory, or because it violates the Charter rights.

Whatever the reason, it will be nice to see the morally repugnant scheme struck down.  And maybe – once I have citizenship – I’ll be more public and vocal in the political process for reform in the system.  As a permanent resident I have to worry about the criminalization of protest in Canada – after all, it only requires one brush with the law and permanent residency can be revoked.  And since permanent residents remain so by the grace of her majesty’s government it’s generally best to remain “below the radar”.

Best wishes for all in 2015!


26 thoughts on “Happy Anniversary!

  1. i just stumble on your blog and i’m happy for you getting your PR through the Spousal sponsor class instead of the Skilled worker category. I found out i’m positive during the immigration medical as well. The clinic get me started on ARV right away and I know it will be a ground for medical inadmissibility. It just hurts that I got infected here in Canada and I don’t know where to get my medications after they get me deported. I guess i just wait for the rejection letter and leave 😦

    • What treatment did they prescribe to you? In which province? HIV is not an automatic basis for refusal and with more and more drugs losing patent status the argument about costs (“excessive demand”) will become more and more difficult for CIC to maintain in the future. For example, I know someone who was on a specific treatment that was all generics. That person was granted PR because they were not excessive demand in any scenario we could construct. Thus, it may also be worthwhile learning what your options are and working with your doctor to see if your treatment can be adapted to your needs to meet the CIC rules.

      If treatment is not available in your home country, as part of your fairness letter response you should document this fact and request that you be granted a Temporary Resident Permit (TRP) on humanitarian and compassionate grounds. While it’s not a guarantee, it’s a reasonable argument to make as well.

      Also, if you can afford to do so, I would strongly suggest you consult with one of the small number of immigration attorneys skilled in this area. Let me know if you need names.

      Finally, while I did ultimately obtain PR via the sponsorship route, there is no doubt in my mind that it happened in no small part to the fact that it looked like I would probably be granted Judicial Review for my FSW application.

      You can prevail, but it takes perseverance.

  2. Dear Friend,

    I came across your numerous post and was therefore decided to contact you for advice and opinion,

    I am a prospective immigrant to Canada, currently awaiting medical request, I am worried because one of my dependent is a sickle cell patient with genotype SC,

    I am contemplating :

    A) not disclosing to panel dr during medical and allowing them to find out by themselves, since it is possible for a patient not to get diagnosed until a old age especially for someone who never have crisis and look very heathy considering all other parameters aside the blood
    B) removing the dependent and changing to non accompany though she actually my spouse
    I really need you opinion while I await medical request as I do not want anything to affect my chance of getting this PR in any way, your help and kind assistance would be appreciated . Thank you as I await your feedback

    • Hello, please did your dependent with genotype SC pass his or her medical exam? A close family friend is worried because of this. Your response will be highly appreciated.

  3. hi my name is noel i was also deemed to inadmissable due health issue (A38) I am principal applicant under CEC with ckd stage 5 wating on transplant list when the decicion came to my attention. my question my relatives is willing to spnosor kidney form the Philippines and if i do that the immgration officer will reverse the decision?

    • If you receive a transplant, the evaluation will be based upon the cost of your continuing treatment, even after the transplant. The cost of anti-rejection drugs is significant.

      My advice is to consult with an attorney specializing in excessive demand medical inadmissibility – CEC applicants are in a very good situation to challenge the entire A38(c)(3) bias in the first place (as someone in Canada can raise Charter arguments more substantially than someone outside).

      • Thank you so much in helping me…. 🙂 last question do u know someone that would help me? God bless u

  4. Congratulations on successfully navigating the medical inadmissibility process.

    I have applied for PR under CEC from Vancouver BC over a year ago, and my 3.5 year old son was assessed to be on the autism spectrum just before our immigration medicals. Our medicals were completed 6 months ago, and I am anticipating a medical inadmissibility letter soon.

    We have completed 2.5 years in Canada and I have been employed full-time during this period.

    Would you suggest that I request GCMS notes?

    We have recently received an RPRF request. What could this mean?

    Any suggestions and advice greatly appreciated.

  5. Hello there – I am so glad you wrote and shared your experience. Reading your research and interpretations has been so valuable to me in understanding this whole “medical inadmissibility” biz. So, I am sponsoring family. father being the primary applicant, mother and Down syndrome sister. Received a fairness letter from embassy.

    I think the evaluation done by the panel physician was not right – I wish I had complained right then and told someone how unprofessional and frankly, stupid, he was. anyway so hence i think the health and social costs that the visa officer has calculated are inaccurate.

    I am fast approaching the deadline for sending back a reply (Yes I have job to hold on to … besides constantly answering to requests from Cnd Immig). I will ask for an extension from the embassy for now. Will do this bit on my own (any particular language you would suggest for the request?).

    But more importantly, I wanted to ask you if you can you please suggest some immigration lawyers (who may specialise or at least have some experience in medical inadmissibility cases). I found 2 in Toronto where I am based but they are really quite expensive to retain. (Initital retainer fee $1500 and $300/hr consulation thereafter – does that sound like the going rate?) Please advise – hoping to hear soon – thanks in advance for your help.

    • how’s your case going on? Do you have these lawyers’ name? Could you please share that info with me? i am in the similar situation right now,, thanks very much in advance.

  6. Dear,

    I’m from China, and is in the process of immigration to Canada via Federated Skilled Worker program.

    My application status is that i received a letter from the CIC, saying that my personal health condition might reasonable be expected to cause excessive demand on health or social services in Canada. To make it specific, my expected cost is $64,579 over five years while the average threshold is $6,387/year.

    I (the principe applicant) took the physical examination on April 1st, 2015 and the result is :
    HBsAg, HBeAg and Anti-HBc positive
    DNA: 1.57*10E8 IU/ml
    HBeAg: 1400+ ( Don’t know the exact value)
    ALT: 18U/L
    B-mode ultrasound: Normal. There isn’t any hepatic fibrosis-renal tubular ectasia syndrome or hepatocirrhosis.

    I have been diagnosed as HBsAg, HBeAg and Anti-HBc positive since my childhood, but was never recommended to treatment because I have a normal ALT and B-mode ultrasound result.

    The VO gave me 60 days to submit additional information to prove that i will not place an excessive demand on social or health services, otherwise, my application will be refused.

    I am writing this letter to ask for your help. I have read your articles and feel you might help me either by giving me some suggestions or providing some attorney name or contact information?

    A quick reply will be greatly appreciated, thanks very much.

    Yours sincerely,

  7. Hi dear friend. ..I got my letter for being excessive demand last April (2014)because I am a kidney transplanted person (about7 years ago). .and in response I sent the
    Documents like the form of ability and intent…and the letter that I will accept all the costs of my medication ..files of private insurance in Quebec that I can use them.. and the most important point .. I calculated and showed them that the cost of my medication is below the threshold. It is 4000 $ yearly…now it is 1 year that I’m waiting…what is your opinion about my case…I am worry about getting refusal letter. ..any answering to me will be appreciated …

  8. Hi there. Ive just finished my medical exam and i have a condition called Corneal Dystrophy. I gave my medical records to my physician to prove i have it since i was born and that i live like this all my life. I am on a waiting list for corneal transplant here in Canada. The medical records do not say that thpugh. Do you think this will make me inadmissible due to excessive demand on Alberta health care? Thank you in advance for your reply!

    • Keep in mind, the issue is primarily about cost. So the answer to your question relates to the cost associated with your condition. Note that if you receive the corneal transplant before the fairness process starts, they would evaluate you based upon your future costs – not on the past costs. I’m not sure what the cost is for a corneal transplant in Canada and how much is covered by the public health system in your province. These are questions you should direct to your ophthalmologist.

      Another possible objection they might raise is about wait times. For many conditions this is not an issue, but corneal transplants are a trouble spot in Canada, with some provinces having 3 YEAR wait times.

      I did find US cost data: http://health.costhelper.com/cost-corneal-transplant.html. If these translate well into the Canadian system (where costs are 40-60% of US costs for comparable procedures) then it would not be excessive demand. That leaves only “increasing wait times” as a potential issue.

      Here’s another article about Alberta trying to fix their wait time for corneal transplants: http://globalnews.ca/news/921645/alberta-takes-steps-to-reduce-wait-times-for-cornea-transplants/ but I’m not sure if they’ve fixed that issue. If they have and the procedure is done by the time you get a fairness letter, the issue will be moot and you won’t be excessive demand (at least not based upon this issue).

  9. Hello everyone,

    I am HIV+ and I am currently on medication (Lamivudine, Zidovudine, Nevirapine) and have an undetectable VL. I ordered my GCMS notes and realised that I have been assigned a medical code of M5. I checked the Ontario Formulary and discovered that the total cost of that specific regimen is around CAD 2700 appox.

    I have since sent a cost analysis detailing the daily, monthly and yearly cost of that specific therapy to the Medical/Immigration Officer at the local VO. I first sent a CSE and followed it up with a hard copy.

    I pointed out the error to them and listed all the references for their own review and confirmation and requested that the correct medical code be alloted.

    Do you guys have any idea what might happen next?

    I also need the contacts of some very good lawyers because I am willing to fight this to the very end.

    Thank you.


    • Right – your therapy combination is not excessive demand and you should use the data that you obtained from Ontario to argue the Medical Officer erred in assigning you an inadmissible rating.

      Since it sounds like that’s what you did, they should review your file and change your rating to M2. If they do not, you have strong grounds to challenge in Federal Court.

  10. Hi everyone 2 years ago I got my pr card and I was living in another country now I want to return in canada and stay there but few months ago I found out I have HIV! What will happen to me? Can I get citizenship or renew my pr card? Please replay my question

    • As a permanent resident, your health status is not a barrier to entry into Canada. Note that you need to meet the residency obligation (2 years in the past 5, or if less than 5 at least the possibility of 2 years in Canada) or they can initiate revocation of your PR status.

  11. Hi

    This is khan. I m in a process of immigration to Canada wit my 4 years child who has developmental delay. Just today I have received fairness letter mentioning that my child will create excessive demand. They ask me to provide a detailed plan. Please help me on this issue. Is there any chance that my application will pass through or this is just the formalities for refusal my application?

    • If you do not respond, they will refuse you. I just posed on another thread about this and I’ll copy the text here:

      Bottom line is that it is normal practice for IRCC to issue fairness letters in cases like your own. Because of the special needs of your child, they will definitely find your application to be excessive demand – the cost of any special education far exceeds these limits. My experience is that attorneys tend to lock themselves into the IRCC paradigm in such cases and refusal is quite common

      I have suggested three novel strategies towards this in the past, but I’ve never seen anyone argue them. I’ll present them here now (I keep meaning to blog about them but there aren’t enough hours in the day!)

      (1) Canada is a signatory to the UN Convention on the Rights of People with Disabilities. This signing antedates the excessive demand provisions of IRPA and thus would be controlling law. Thus, it is a legal mistake for IRCC to focus on one application of law, rather than the newer. Of course, IRCC may take the position that the UN Convention isn’t applicable, but it would argue that Canada’s status as signatory is empty if they are not willing to abide by the terms of the Convention (“lip service”).

      (2) Canada is also a signatory to the UN Convention on the Rights of Children. I don’t recall if the signing antedates this section of IRPA, but the IRPA is general and the UN Convention is specific, so once again, it could be argued that the UN Convention is the binding law and that IRCC is making a legal error in not considering it.

      (3) The manner in which IRCC applies the excessive demand provisions is a form of “reverse cherry picking” – they take the highest cost person in a group application such as yours and compare it against the average cost for Canadians. By doing so they will reject a group application where the average cost of the group is lower – hence, this creates a discriminatory approach to the process. I would argue this violates natural fairness because it finds everyone in the group inadmissible because of one individual of the group. I cannot see how that approach is reasonable.

      These are all legal arguments though. Thus, it would likely require a refusal by IRCC and a subsequent Federal Court application for them to be fairly considered. You might share this with your legal team and ask them why these are not valid arguments (I’m not a lawyer and they might have reasons for not taking this approach.)

      There are attorneys that have excellent track records in cases like yours, but they are expensive as well.

      Good luck! You can fight and win but be prepared because it isn’t an easy path.

  12. Hello, just unexpectedly read this blog and its been a while since i am looking for a blog to answer my questions. I have a spouse with Permanent resident in canada and i am living with HIV for three years and under ARV. I think i am in good health with high cd4 and low viral load. How many percent is my chance to get a PR? I am worried i will be decline wih status.

  13. I am positive with HIV and i have a spouse in Canada. I have a good medical records and healthy. What is my chance of getting approve? Thanks in advance.

    • Normally this is not an issue for spouse/partner applicants because you are “Excessive Demand Exempt” (EDE). Note that the protocol for this is listed on the IRCC website and can be quite lengthy. What I would recommend is that you disclose this information in your application, include documentation that your spouse is aware of your medical condition and wishes to sponsor you despite the condition and a release so that IRCC may discuss your portion of the application with your sponsor. In that way, the mandatory interview and 60 day review period for your sponsor to review is not necessary. This can save as much as two years off the application process. While IRCC may still follow their own protocol from what I’ve seen this type of documentation generally allows them to bypass the process.

      Because you are EDE, your health condition’s cost of treatment is not a valid basis for refusal. They can refuse your application on other grounds, but not on excessive demand medical grounds.

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