The letter usually starts with careful, frightening language. An officer writes that a family member “may be inadmissible” on health grounds, describes a condition, gives a dollar figure, and sets a deadline. Many people in Brampton who receive one assume the file is finished, and that the choice is to leave a child behind or give up on Canada altogether. That reaction is understandable. It may also be wrong.
A procedural fairness letter is not a final refusal. It tells you what the officer is concerned about, and gives you a chance to respond with evidence. The law on medical inadmissibility is narrower than people assume, and it treats different diagnoses, and different types of applicant, very differently. Many health conditions create no immigration issue at all.
This is general information and not legal advice, and it is certainly not medical advice. Immigration, Refugees and Citizenship Canada (IRCC) adjusts its instructions and figures, so please confirm them on IRCC’s website. If you have received a letter, the deadline in it takes priority over anything you read here.
The Three Grounds
Section 38 of the Immigration and Refugee Protection Act sets out three separate grounds. A foreign national may be inadmissible if their health condition:
- Is likely to be a danger to public health. Officers consider the immigration medical exam, lab results and specialist reports, including infectious diseases such as active tuberculosis or active syphilis, recent close contact with someone who has one, and how the condition could affect people in Canada.
- Is likely to be a danger to public safety. The focus here is on the risk of sudden incapacity, or of unpredictable or violent behaviour.
- Might reasonably be expected to cause excessive demand on health or social services. This is the cost-and-wait-time ground, and it comes up far more often in ordinary family and work applications.
The first two are rarer but more absolute, since none of the exemptions described below apply to them. Treatment can matter a great deal, though. A person with active tuberculosis who has been treated and is no longer infectious is in a very different position from someone with the disease untreated.
What Excessive Demand Means
The third ground has two parts. A condition may cause excessive demand if:
- The anticipated cost of the health and social services the person would need would likely exceed the cost threshold, or
- The needed services would add to existing wait lists in Canada in a way that would negatively affect wait times.
The cost threshold is updated each year. IRCC’s figure for 2026 is $144,390 over five years, or $28,878 per year. Check IRCC’s website for the current number, since it changes annually.
The usual period assessed is five years, though it can be up to ten in cases where the need is expected to rise significantly. Officers look at conditions such as chronic kidney disease requiring dialysis, some cancers, conditions treated with expensive medications, and certain developmental disabilities needing publicly funded support. The specific diagnosis is less important than the services you are likely to need and what they would cost.
Two misconceptions are worth addressing. First, a diagnosis does not itself lead to a finding. People with diabetes, controlled high blood pressure or HIV may fall well below the threshold depending on the treatment required. Second, a person’s wealth does not, on its own, solve the problem. You cannot simply promise to pay for everything. But financial means can matter for some services, and this leads to the idea of a mitigation plan, discussed below.
Who Is Exempt from the Cost Rule
Excessive demand does not apply to everyone. Under the Act, the exception covers:
- Sponsored spouses, common-law partners and dependent children in the family class, or the equivalent in the Spouse or Common-law Partner in Canada class
- Convention refugees and people in similar circumstances applying from abroad
- Protected persons
- Certain family members of the people in these groups
This is a very important protection for a family sponsoring a spouse. Consider the hypothetical of a Brampton resident sponsoring his wife, who has a serious medical condition. If she qualifies as a sponsored spouse, excessive demand should not be a basis for refusing her. She would still need a medical exam, and public health and public safety grounds would still apply.
The exception does not cover everyone in a family, however. It doesn’t generally extend to sponsored parents and grandparents, or to economic applicants. So a parent applying under the Parents and Grandparents Program, a skilled worker in Express Entry, or a provincial nominee can be assessed on cost. Some visitors, students and workers are required to have medical exams, too. A visitor could face a public health or public safety finding, and the cost assessment may arise for longer stays, though its effect depends on the type of application and the length of stay.
Children and dependants can complicate the picture. An economic applicant with a dependent child who has high support needs may find that the child’s assessment affects the entire application, including where the child was not going to come to Canada. Non-accompanying family members generally still have to be declared and often need to be examined. Leaving someone off your forms to avoid the issue can lead to much more serious consequences than the medical issue itself.
Reading the Letter Carefully
A procedural fairness letter on medical grounds should give you the condition, the medical officer’s opinion, the services expected to be needed, and the estimated annual cost. It also sets a deadline for a reply. IRCC’s published guidance says the response must be sent within 90 days of the letter’s date, and if you need longer, you can contact the listed office to request an extension. Follow whatever your own letter says. Dates can matter a great deal here. Get specialist appointments booked immediately, since they may take longer than the response period in Ontario.
Read the letter with three questions in mind. Is the diagnosis correct and up to date? Are the services listed what you really need, or are they what the medical officer assumed? Are the costs accurate? Medical opinions are based on the records available to the medical officer, and the records may be out of date, or incomplete, or may assume a higher level of care than you need. You will often need your own treating specialist to look at the letter, and to address those points directly.
You may wish to ask for your file notes through an access to information or privacy request, to see the details of how the opinion was reached. Do this right away, since a response could take longer than expected and should not hold up other parts of your reply.
Building a Response
A useful response is organized, specific, and tied to the concerns in the letter. It often includes some of the following.
Updated medical evidence. This could be a letter from your treating specialist that explains your diagnosis, how severe it is, your current treatment, how you’ve responded, your prognosis, and what services you are likely to need over the next five years. General statements such as “the patient is doing well” do little. A doctor who writes “this patient has been stable on this medication for three years and does not require hospitalization or home support” gives the officer something to work with.
Corrected cost information. If your medication is cheaper than estimated, or your treatment plan differs, show the actual figures. Ask pharmacists or specialists to document this, using costs that apply in Ontario where possible. Be aware that some provincial drug benefits vary with circumstances.
A mitigation plan. Where you are invited to submit one, and where it applies, a mitigation plan explains how you will reduce or offset the demand on publicly funded services. It might describe private insurance, employer drug coverage, or private payment for some social services. The courts and IRCC’s guidance draw a distinction between different kinds of services. In general, it can be more realistic to offset social services than publicly insured physician and hospital care. A plan must be credible and specific, with an honest budget and proof of funds. A statement such as “our family promises to pay” is rarely going to be persuasive by itself.
The person’s circumstances. Include things like the role of family in Brampton who will provide care, whether the person has a realistic plan for work, and any community support. These matter more in some arguments than others, but they can provide useful context for the officer and may help if humanitarian grounds are later considered.
A lawyer can help turn those pieces into a clear submission. A stack of medical records with no explanation of how they answer the letter leaves the officer to work that out alone, which helps no one.
If the Application Is Refused
A refusal does not always end the matter. Depending on how the application was made, you may have one or more of the following options.
Judicial review. You can ask the Federal Court for leave to review the refusal. It’s not a new hearing on the medical evidence. The question is whether the decision was reasonable and fair, for instance whether the officer dealt with your evidence. Deadlines are short: 15 days for a decision made in Canada, and 60 days for one made outside Canada, with limited room for extension.
Appeal. A sponsor in a family class case may have a right of appeal to the Immigration Appeal Division in certain cases. Appeals have their own rules and timing, so check your refusal letter closely.
A temporary resident permit. An officer can issue a permit to someone who is inadmissible where it is justified in the circumstances, and a person inadmissible on health grounds may eventually qualify for permanent residence through the permit holder class after three years of continuous residence on permits.
Humanitarian and compassionate grounds. An application under section 25 may be another option in a compelling case, particularly where children’s interests are involved. It is discretionary and depends on a full picture of the circumstances.
Reapplying later. A condition may improve, or a treatment plan may change enough that a new application makes sense, but only if there is a real change to point to.
Things to Avoid
- Do not skip disclosing a family member or a condition on your forms, or tell the panel physician something inaccurate. Misrepresentation can result in a five-year bar, on top of the original problem.
- Do not stop treatment, or change medication, to look healthier on paper. That can harm your health and may be evident from your records.
- Do not ignore the letter while you wait for a specialist. Write to the office before the deadline to explain what is coming and ask for an extension if you need one.
- Do not assume that a successful medical exam last time means that you are clear now. Immigration medical results have limited validity and health can change.
A Sensible First Step
Medical inadmissibility is one of those areas where the law and the personal stakes both run high. If you are in Brampton and have received a fairness letter, gather your letter and your medical file and take them to your doctor first, then ask for legal advice with enough time left to make use of it. Our immigration law team can review the letter and explain your options, or you can read about permanent residence applications on our site. No outcome can be promised, but a careful response gives the officer the information needed to make a fair decision.