In 2005 I decided I wanted to move to Vancouver, BC.  There were a variety of reasons for this, not the least of which was that I liked Vancouver.  I also liked Canadian social tolerance versus the rising tide of intolerance I saw in my own home country of the United States.

At the end of 2011, I was formally rejected for permanent residence in Canada.  While I’ve been working on achieving permanent residence in Canada for the past six years, my journey to achieve this has not yet been achieved.   Indeed, all that has happened is that it has moved into a more challenging phase.

Thus, I decided to start this Blog in order to capture my experience in hopes that it will both help me organize my own thoughts as well as help others who might find themselves in a similar situation.


35 thoughts on “About

  1. Hello there,

    I found you on the canadian visa forum, and also found your blog last week. I have read your blog all week, to know about your story.

    I have the same problem. I have applied for PR in Canada. I’m student here doing my PhD. I have M.S. and I did not know that this may cause problem with my PR situation. When I got my medical exam, I worte about this problem, and now I got a letter saying that I should get a letter from my neurologist, and they will assess my case after that.

    I hope you read this comment here, please help me. I don’t know what to do 😦


    • You’ve started down the road of medical inadmissibility.

      The letter is the request for “additional medical information”. The key here is that the opinion of your neurologist must be that you won’t require more than ~$6,100/yr in publicly funded health care services over the next five to ten years. The stronger that conclusion, the more likely you are to complete your journey without any further complications.

      That cost number is set once per year (it is due to be set again any time now, since they normally do it around the beginning of December). It includes medical expenses as well as social service costs. It doesn’t need to include expenses that would not be eligible under your province’s health care plan.

      So a letter from your neurologist saying “my patient’s condition is stable and with appropriate treatment is most likely to remain stable for the next five to ten years” and also “I would estimate costs for treatment to be no more than $6,100 per year in either the five or ten year time frame.” But your doctor may not be comfortable saying that. If it still seems more likely than not that you won’t need “excessive care” then you should be fine.

      If the immigration medical team thinks that you will exceed the “excessive demand” threshold then you will be given a fairness letter.

      If you get a fairness letter, you really need to find an attorney specializing in medical inadmissibility. That response letter sets the stage for any subsequent challenge and is very important if you wish to challenge the finding.

      Things you can do: find out your province’s coverage. The best attorneys are in Toronto, but they don’t necessarily know the details of your own province’s health care coverage. For example, here in BC we have the option of “opting out” of health care. This is not an option for most other provinces (I could only find Alberta with a similar option). Drug costs and coverage are also important to understand.

      In the end, you need to also educate yourself. The current scheme of medical inadmissibility is fundamentally flawed and hopefully it will be corrected at some point, but in the meantime you are still your own most loyal advocate.

      Good luck!

  2. Hi There, n happy new year!

    Many thanks for your really complete answer. Based on this I think I gonna have major problem, cause my medication cost $30000 per year. I talked with some lawyers and sent my neurologist letter to get the fairness letter. The lawyer I choose was Bellissimolawgroup, which are based in Toronto, and I heard that they are really expert on the field. They will charge me $5000.

    I do not know if I have any chance once I get my fairness letter, what do you think?



    • Bellissimo does a very good job in the area of medical inadmissibility, winning the Sapru decision a couple of years ago for example. While they cannot guarantee you success, they should be able to assist you in putting together the best possible response to the fairness letter. The key really will be medication costs. If the medication is covered by the province then yes, you will likely have a problem. Then you must ask yourself if you want to go to court over the issue. Two of the arguments my own attorney presented might be applicable in your case as well: that the excessive demand clause violates the Charter, both in terms of your disability as well as the separation of powers argument. The former has been raised previously but the latter has not – and that latter argument will be interesting when it finally does reach the courts because the case law that says “health care belongs to the provinces” is very strong – yet that is precisely what IRPA is attempting to legislate in this case.

      Just know that this process doesn’t move quickly. I found it was best to focus on other things as much as possible because the process itself is a real challenge. I suspect one reason why more people don’t challenge poor decisions in this area is how difficult it is in terms of the personal toll.

      Fortunately, you have a PhD program to keep you occupied. Best of luck on it!

  3. Hi again! Alan’s here!

    So, Bellissimo sorted out a very good response for my case, and they sent it around a month ago. Now I have to wait and see what the response will be. How long it will take for them to consider my case? How long it was for you?


  4. I found your message on canadavisa.com ..I really apreciate your work . My id is canadacalling2012 if you remember… yesterday I have received an wmail from embassy asking me to provide fairness letter. I am from india. Please help me out in giving the best reply . As I m priciple applicant and hiv negetive . My spouse is hiv positive. Please mail me some details on my mail id xxx asap. Waiting for your quick reply

  5. Hi there,

    I did read most of your story on this weblog and I can only say bravo!!! what a great and informative weblog. I came to Vancouver, Canada in 2008 as an international student and I finished my PhD (in computer) in 2012. I am a person with physical disability and using power wheelchair to get around. I am living with my wife and she helps me for getting bath and personal works. However I’ve got well-paid job and going to work every day by my own (the company I am working for, provided me a full medical health insurance). Also, I have no medication cost and I have not used any social services during the last five years (nothing reported for tax return). I applied for PR and they just asked me for medical examination. I have no idea what to do. I am worried about the physician note as he may feel that I need caregiver and my body is getting worse every year. I appreciate if you give me some comments. Is it important to talk with a fair physician beforehand? Please help me.

    • Hello,

      I am back. I just want to inform you that I finally got my PR. Thank you very much for you very helpful weblog and also your supports via email.

      good luck, man!

  6. Hello there, we are also facing a very challenging situation right now with Canadian immigration regarding medical inadmissibility. Iam the principal sponsor for a federal skilled worker application and set to migrate to canada but unfortunately I was diagnosed with HIV. We already received a “fairness letter” from the embassy and given a 60day period to comply. What are the best option we can do now? Do we need legal advice at this time? Who do you recommend? How can I communicate with you further? Hopefully you can also help us.

  7. Hi there, ive seen your post in canandian visa forum and I appreciate your help and response. As a family we are also facing a difficult situation as well regarding medical inadmissibility for Canada under federal skilled worker visa. Iam the principal sponsor for our family but unfortunately has a meical diagnosis of HIV which lead us to received a fairness letter and a probable candidate for medical inadmissibility due to above diagnosis. What are the best option we can do? Who to ask for legal advise? Hopefully you can help us in our situation. Thank you!

    • I would strongly urge you to work with Michael Battista as this really is his expertise. He has guided many people through this process and if you are refused he can assist you in challenging what is clearly a morally corrupt process of discrimination.

      If you need to do this on your own, look at the information here and ask questions.

  8. I’m thinking of moving to Québec until 2018 from Mexico. I’m HIV+ since January 2014. The patent of my medication (Atripla wich is a combination of EFIVARENZ + EMTRICITABINE + TENOFOVIR) will expire on Canada on 2 February 2018. Teva, an Israeli generic producer has said that they will launch the generic version of this medication, so the price will be very low. Québec health services has a list of the medications that are covered by the province, and the maximum commercial prices, so it’s the maximum price allowed for any pharmacy in the province. EFIVAREZ has expired 2013, and now you can buy it at $30 CAD monthly, but the other two aren’t so cheap already, until 2017. My doctor, from the best and most experienced HIV institution of Latin America, says that perhaps next year if I have full adherence to my treatment, I will need CD4 and viral count blood exams 3 times a year, and I could be in this medication for my whole life (as he says that he have patients with the same treatment for over 20 years), so I could be under the $6,100 annual threshold.

    I’m afraid that CIC will put a lot of pretexts to reject my PR. How could they know the real amount on social services and health cost over 10 years? Does the doctor that do the medical examination is an HIV specialist? Do they know everything about actual medications or future medications? Do they know how my body will react in those 10 years? Can he know if my treatment will lose effect on those 10 years, and then change it for a new and expensive one? Can CIC deny my PR if nobody, even a Canadian doctor, will predict the exact future of my health? If they say no, because they cannot be sure that I won’t change treatment in those 10 years, could that be take as discrimination?

    I have heard about Companioni VS Canada case, a HIV+ couple from NYC that wanted to move to Toronto and won their case. In the both versions (French and English), the text said that the couple submitted information from his USA doctor, whom said they were healthy and just needed some medical checks on a year. A doctor who works for the HIV and AIDS Legal Clinic Ontario checked this information and gave his approval. The immigration practitioner didn’t reject the information, so the CIC official and the Supreme Court of Canada sanction that excessive demand on social services didn’t apply. The problem was the cost of their medication, which is too expensive, and Ontario will cover it, so the excessive demand on health services did applied (they also gave the exact cost of their treatment on Canada, $33 000 CAD a year).
    But I read that Supreme Court said that CIC should have thought on the patent expiration of their medications, that the threshold will increase every year, and that they have the exact amount of money to pay for its medicines for the 10 year period on a private medical insurance, if they couldn’t get it from their job while in Canada.

    I know LEGIT QUEBEC, a registered non-profit association which helps people like me in these cases, as I won’t be able to pay $5000 for BELLISIMO.
    I’m so worried. Many people talks about Canadian tolerance and humanity, but I think that is not, I think Canada, specially the English speaking part is hypocrite and just don’t want us although we can give them so many positive things.

  9. Hello there,

    Your posts are very informative and contains tons of details. I am also in the similar boat and have applied for permanent residence under FSW 2014 plan. I am just done with the medicals and the doctor has asked me to get the referral filled by hematologist which talks about the prognosis and plan for next five years. The doctor has provided his response back, I am in the process of sending it across to the primary doctor to share with CIC.
    Actually my youngest son (3 years old) has “Beta Thalasemmia Major”, for which he has to go through blood transfusions every four weeks and is on iron chelation medication. The cost threshold seems high but insurance cover 100% of the transfusion and the co-pay assitance program cover the drup cost upto $20, 0000 per year in the USA.

    I am thinking that once the doctor submits the medicals to CIC, I will get a fairness evaluation letter asking for an alternative plan for excessive demand. Is my assumption correct ?

    What do you think I should do ? Need expert advice here.

    Thank you in advance

    • You should select an immigration attorney with experience in excessive demand medical inadmissibility cases. The issue is primarily one of cost, since in Canada those costs are paid for by the public insurance system. Indeed, in many ways, the current Canadian system is much like the old US system where health insurance companies would refuse to cover people with pre-existing conditions.

      From what you have described, it does seem likely that you will receive a fairness letter. If you wish to be successful, your best option is to work with one of the handful of Canadian immigration attorneys that have experience in this area. Such an attorney can help you prepare a fairness response letter. Note that because every condition is individually evaluated, there is no single form letter for a Fairness Letter response. But an attorney can help you construct various arguments. In your case, for example, they might be able to find a private insurance policy that would continue to cover your son, even in Canada. Such a mitigation plan can sometimes overcome the medical officer’s opinion. In addition, a lawyer can also lay the groundwork for a challenge of a refusal (should you choose to challenge it in Federal Court). As I’ve pointed out previously, Canada is signatory to multiple international agreements that stipulate they will not discriminate against people in the way that it seems the current excessive demand framework discriminates. But fair warning: challenging CIC in Federal Court is stressful and expensive and there is never a guarantee of success (though your odds of success are vastly higher when you have a good attorney!)

  10. Hi there, my mother has chronic kidney disease and soon will be on dialysis. I am canadian citizen and I am sponsoring her. I know that my case will be denied. When should I involve a lawyer? After I am refused or before? do you know anythin g about this topic?

    • The best time to involve an attorney (especially if you plan on challenging a refusal) is during the fairness response stage. A good attorney will respond in a way that creates grounds for a subsequent challenge of a refusal. If you wait until a refusal, an attorney will be much more limited in what they can argue, because if it wasn’t presented to the medical officer and/or visa officer, then it cannot be argued before a Federal Court judge.

  11. Dear computergeek,
    I have sent you a pm on canadavisa.com. please do reply. Can you also suggest a good attorney specializing in medical fairness letter reply.



  12. Hi there,
    i found myself in the same boat HIV Fairness letter. I wrote you a private message on canadavisa. Could you please help me with guidance?

  13. HI there! I’ve been following your suggestions and advice on canadian visa forum and you I am totally impressed. With your expertise, I want to ask your comment on our case.. We received a refused decision due to Police Certificate, last November 2014 but able over turn it on January 2015 and VO continued the processing of our application. Just this November 2015,, we received a remedical assessment, but, with the turn of events.. During remedical, my Father had an incidental findings of PNEUMOTHORAX. He undergone a minor surgery and is OK now. But during follow up with the DMP, the Medical Officer stated in his findings that my father has COPD, stable. My father is also Diabetic but was cleared during the initial medical. My father is taking two bronchodilators. My question is, in your opinion , should we expect that this case will be deemed Medically Inadmissible due to Excessive Demand? Thank you. Hoping for your response!

  14. Hello Computer geek,
    I’ve read all your comments on this page and the forum. Thank you for what you do.

    Do you know cases with Crohn disease?
    I was diagnosis 2 years ago. I was on medication (Infliximab) which is quite expensive in France and I think in Canada too.

    Because I had no symptoms for more than 2 years I start to ask for medical exams to change my medical plan.

    So during 6 months I took the time to do a lot of medicals exams and my doctor said “We can stop your medical treatment”.

    It would mean that I won’t cost anything anymore but we can’t predict it for the next 10 years…

    I may be soon nominated and receive an ITA before to do the medical visit, what do you think? Should I contact right now an attorney? If so, do you know someone? Can I contact him by mail because I’m in France?

    Thank you,
    Kind regards,

    • Don’t waste your money consulting an attorney before there is an issue! When you get an excessive demand letter (“fairness letter”) then you have plenty of time to find an attorney and develop a response plan. Doing so prematurely will be expensive, especially in a case like yours where it doesn’t seem like you are excessive demand.

  15. Hi there,
    I am currently sponsor my parents to immigrate to Canada.

    Recently CIC has asked my mother to conduct a second medical examination due to her hip problem (Femoral head necrosis). My mother had this issue since her born (Hereditaryly from my grandmother), and currently she can walk freely at home and only need a stick when she walk outside. She is refused to the hip replacement as she prefer her own natural hip.

    I am not sure if she qualified under Medical inadmissible for hip issues.

    As I am the only child in the family as these days I am extremely stressed if she falls into Medical inadmissible.

    Like to get your advice of the next step in case this happened to me.

    Thanks and regards


    • I always recommend waiting for a fairness letter, though it is likely in her case if the cost of hip replacement exceeds the five year cost. The best option is to have it done – once done, IRCC won’t consider its cost (because it is a future analysis, not a past cost analysis).

      Good luck!

  16. Hi there! I saw your posts on Canadavisa.com helping out applicants with medical Inadmissibility, and I’m wondering if you would be able to help me out…I applied under ON PNP CEC, just received procedure of fairness letter. I’m currently under treatment for Hep B, they deemed that total cost per year is around $7300 – if you can send me a quick email I can show you the details of their assessments…Is there any chance I can fight for this? Your help is much appreciated. Thank you!!

    • At a cost of $7300 you’re very close to not being excessive demand. Are their costs reasonable? Is the entire cost paid for by the Province? If some portion is paid for by you and/or your insurance, then you are below the excessive demand threshold. If the drugs you are on lose patent status within the next 5-10 years then you can argue that costs will fall – even a single year at half that cost could push the five year total below the excessive demand threshold.

      You can definitely fight this. I’ve seen many Hepatitis B positive people win – IRCC has a habit of picking the most expensive treatment option rather than your own treatment option and ignoring private insurance (which they are not permitted to do under the Companioni decision).

      If you can afford to work with an attorney experienced in excessive demand medical inadmissibility your chance of success is much higher.

      Good luck!

  17. Hi, your blog very useful and I am based in calgary- alberta. Family and I applied for PR april 10 2014, son had to do 2 medicals and was diagnosed with autism and severe speech delay attended a special needs school for 3 years and received PUF funding and is now in a normal school but a special needs class so stI’ll has the teacher, speech therapist and occupational therapist. Got a letter from immigration last friday medical inadmissability and have a option for fairNess letter. I googled for immigration lawyers and came across Stewart sharma and raj sharma who had good reviews in this regard. Went to see them today and what else can I do on my side to further assist the lawyers because I didn’t seem to satisfied with the meeting or the next steps or I don’t know if there is so much going on in my head that I’m even doubting myself with even going to a lawyer in the first place. My son doesn’t require any medication and we have extended Healthcare. We have never used extra home supervision and we pay for babysitters or extra special needs activities out our pockets. Any advice /suggestions welcomed

    • Bottom line is that it is normal practice for IRCC to issue fairness letters in cases like your own. Because of the special needs class, 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 other attorneys that have excellent track records. I don’t know the Sharmas and they may have a track record of success in Federal Court but that can be confirmed by searching the court decisions to see if they have been on the winning sign.

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

  18. I really want to thank you for this great effort. You are the only source on the whole internet talking about this issue. so, keep it up. I tremendously need your advice. I am diagnosed with chronic kidney disease stage three. Almost 3-5 years apart from complete renal failure(dialysis OR transplantation). My medications right now cost less than 5000$ and also after the transplantation will be the same.
    So what is your advice for my case..Should I apply for PR ASAP making use of that I don’t need dialysis or transplantation in the upcoming five years? Or should I wait till I do the transplantation and then I apply? and anyhow how much is the privet insurance? and Does it really useful?

  19. I really want to thank you for this great effort. You are the only source on the whole internet talking about this issue. so, keep it up. I tremendously need your advice. I am diagnosed with chronic kidney disease stage three. Almost 3-5 years apart from complete renal failure(dialysis OR transplantation). My medications right now cost less than 5000$ and also after the transplantation will be the same.
    So what is your advice for my case..Should I apply for PR ASAP making use of that I don’t need dialysis or transplantation in the upcoming five years? Or should I wait till I do the transplantation and then I apply? and anyhow how much is the privet insurance? and Does it really useful?

    • The concern would be that IRCC can choose either 5 or 10 year time frames. If you won’t need services in that time, then you should be fine. If you do, then they are likely to find you inadmissible. If you do the transplant now, you will almost assuredly be excessive demand – the ongoing drug therapy cost alone is enough to make you inadmissible. I’d suggest consulting with an attorney skilled in excessive demand cases.

  20. Hi,
    I got your website through the Canadvise website and I have read a lot of comments on different scenarios, well done. I have a son diagnosed with Downs syndrome, born in the US 4 years ago. Hes been getting therapies and all and hes doing well. No heart conditions, no surgeries apart from the fact that hes getting therapies to help his improvement. Just got a fairness letter and I am wondering our chances. Can we base our letter on the premise that since hes a Us citizen, and since he has Medicaid/guaranteed Insurance, if there is a need to get any major health concern sorted( which he has not required since birth), he can always get that at his home country. What other documents would you suggest er ass to our submission and Must we necessarily use an attorney and Is there an email I can reach you at?
    Thank you

  21. Hello there,

    Today, I received a request for information from CIC. I am currently taking a medication which prevents HIV. It is also known as PrEP.

    While, I do not have HIV, I have been taking this medication simply as a precaution.

    Here’s an excerpt from CIC’s letter:

    The expected cost for health related services for this applicant is approximately $12,000 per year.
    This amount exceeds the average per capita threshold of $6,655.00 annually. A detailed list of
    services required, cost implications as well as sources used to determine these costs are included
    in Appendix I.
    Based upon my review of the results of this applicant’s immigration medical examination and all
    the reports I have received with respect to the applicant’s health condition, I conclude that this
    applicant is inadmissible under Section 38(1)(c) of the Immigration and Refugee Protection Act
    which states that “A foreign national is inadmissible on health grounds if their health condition
    might reasonably be expected to cause excessive demand on health or social services.”
    Senior Medical Officer – Immigration, Refugees and Citizenship Canada (IRCC)
    Appendix I: Expected Costs of Services
    Details of Services: Truvada one tablet per day
    $ 12,000 per year

    Date Accessed: February 10, 2017

    Before I make a final decision, you have the opportunity to submit additional information that addresses
    any or all of the following:
     the medical condition(s) identified;
     medication(s) required in Canada for the period indicated above; and
     your individualized plan, including financial arrangements as applicable, to ensure that no
    excessive demand will be imposed on Canadian social services for the entire period indicated
    above and your signed Declaration of Ability and Intent. The expected cost for health related
    services detailed above represents the publicly funded cost or subsidy provided by your
    province of destination. Therefore, your individualized plan, should include your ability to
    cover the total, non-subsidized cost of your specific treatment. Please include documentation
    to substantiate your projected total non-subsidized medication costs.
    You must provide any additional information by April 13, 2017. If you choose not to respond, I will
    make my decision based on the information before me, which may result in your application being

    In order to demonstrate that you will not place an excessive demand on health or social services if
    permitted to immigrate to Canada, you must establish to the satisfaction of the assessing officer that you
    have a reasonable and workable plan, along with the financial means and intent to implement this plan, in
    order to offset the excessive demand that you would otherwise impose on health or social services, after
    immigrating to Canada.

    I would like to write to CIC and explain them that I’m not depended on this medication and would rather stop taking it, than being considered inadmissible. Since this medication is being full covered by my insurance, I requested my doctor to prescribe it to me.

    Unfortunately, I won’t be able to prove my financial ability for my medical costs for 5 years.

    The only valid reason I currently have which can perhaps ensure that I will not take this medication any more, since I’m in a relationship. However, I do not have anything to back my relationship with my partner, such as a marriage or a domestic partnership certificate.

    I can also perhaps try and get a letter from my physician stating that the medicine was simply prescribed on my request. Being at risk is debatable, since there are many people who don’t get tested and have no clue of their status. This will entirely depend on whether the medical officer will consider me risky or not.

    Is there any other way to go about it? Any suggestion/advice is welcome?

    Thank you.

  22. Thank you for setting up this blog. This has been the most helpful and comforting article in the internet so far!

    My DMP found a lung mass in my chest xray. I did 2 views and still the mass is there so he said he will submit it to CIC and wait for further instructions. I’m also following up on this on my own because I want to find out if it’s anything serious.

    I’m in Canada right now and applying and inland and I really want to stay in this country. I read in the posts above that I need to hire a lawyer for my case. I keep reading good reviews about Bellissimo law group but I heard they charge 5000$!

    I’m curious, if there’s really something wrong with me…how else would my lawyers argue the medical inadmissibility?

    I’m currently employed and with a comprehensive private medical insurance but my contract is up to end of this year only. Do I need to find another job that will give me private insurance so I can prove that I can cover my own expenses?

    Also..maybe a stupid question….even if prove to CIC that I have private medical insurance how will they make sure that I won’t just rely on OHIP once I get permanent residence?

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