Your permanent residence application was going well until the immigration medical. Now there is a letter saying that your son’s condition “might reasonably be expected to cause excessive demand on health or social services” and inviting you to respond within a fixed number of days. Nobody has explained what the phrase means, what the officer is actually measuring, or what a useful response would contain. This post covers all three.
The three grounds of medical inadmissibility
Under the Immigration and Refugee Protection Act, a person may be found medically inadmissible if their health condition:
- is likely to be a danger to public health, which in practice means certain infectious diseases;
- is likely to be a danger to public safety, which is rare and concerns conditions associated with unpredictable or violent behaviour; or
- might reasonably be expected to cause excessive demand on health or social services.
The first two are uncommon. Excessive demand is the ground that affects most families, and it is the focus of what follows.
What excessive demand means
The test is financial, not moral. A condition causes excessive demand if the anticipated cost of the health and social services it will require exceeds a cost threshold, or if it would add to existing waiting lists in a way that delays care for people already in Canada.
The threshold is set each year and is currently pegged at roughly three times the average per capita cost of health and social services in Canada. The assessment normally looks at a five-year period, extended to ten years where significant costs are expected to arise later. Since 2018 the definition of social services has been narrowed: special education, social and vocational rehabilitation, and personal support services are no longer counted, which removed many children with developmental conditions from the reach of the provision.
The medical officer’s opinion is based on the panel physician’s report, any specialist reports, and published cost data. That opinion is what the visa officer relies on, and it is what a response has to engage with.
Who is exempt
Excessive demand does not apply to everyone. It cannot be used against:
- a spouse, common-law partner or dependent child being sponsored in the family class;
- Convention refugees and protected persons and their family members; or
- certain other categories set out in the regulations.
Danger to public health and public safety still apply to those groups, but the cost-based ground does not. If you are sponsoring a spouse or child, a letter raising excessive demand is likely an error and should be answered on that basis.
One family member, whole application
Medical inadmissibility is one of the grounds where a family member’s condition can make the principal applicant inadmissible. In most economic and family categories, an inadmissible accompanying family member renders the entire application refusable, and in some categories the same applies to non-accompanying family members who were required to be examined. Leaving a family member off the application to avoid the issue is misrepresentation and creates a far worse problem.
Responding to the procedural fairness letter
Before refusing on excessive demand grounds, the officer must send a procedural fairness letter setting out the medical officer’s opinion, the anticipated services and their estimated cost, and a deadline for response. This is the decisive stage. A response can challenge the finding on two fronts.
The first is the medical assessment itself. Updated specialist reports may show the condition is milder, better controlled, or less likely to require the services assumed. Cost estimates are frequently based on generic assumptions that do not reflect the actual treatment plan.
The second is a mitigation plan. Following a leading Supreme Court decision, officers must consider the applicant’s ability and intention to mitigate the demand. A credible plan might show that medication is available through private coverage, that the family has the means to pay for services privately, that a specific treatment reduces the need for future care, or that the services in question are not publicly funded in the intended province. The plan must be realistic, documented, and specific to the province of destination.
If the application is refused anyway
In a sponsorship case, the sponsor can appeal to the Immigration Appeal Division, which can consider humanitarian and compassionate factors as well as the legal validity of the refusal. In economic categories, the remedy is judicial review at the Federal Court within the applicable deadline, which we describe in our post on judicial review timelines. A Temporary Resident Permit may also allow entry for a defined purpose while a longer-term solution is pursued.
Our post on being found inadmissible and our inadmissibility page cover the wider range of grounds and remedies.
The response window is short and the stakes are high
A procedural fairness letter on medical grounds usually allows a limited time to respond, and gathering specialist reports and a mitigation plan within that window takes organisation. If you have received one, book a consultation with Kabir & Alam Lawyers immediately. We can assess whether the ground even applies to your category, obtain the evidence that answers it, and prepare a response the officer is obliged to consider.