Medical Inadmissibility – Excessive Demand

Medical inadmissibility based on “excessive demand” is one of the most detailed, evidence-heavy, and analytically complex assessments in Canadian immigration law. Under IRPA s.38(1)(c), an applicant may be refused permanent residence if their medical condition is expected to place an excessive demand on Canada’s publicly funded health or social services. This legal test requires an individualized assessment that examines the anticipated cost of care, the availability of mitigation plans, and the applicant’s specific medical profile. Because the excessive demand threshold is updated annually, and because IRCC must consider personalized cost-reduction measures, legal counsel plays a critical role in preparing comprehensive responses to Procedural Fairness Letters (PFLs) and constructing detailed cost-mitigation strategies. Let's have an exhaustive, lawyer-level analysis of excessive demand, applicable jurisprudence, evidentiary requirements, and best-practice strategies to successfully overcome these findings.

Excessive demand inadmissibility frequently arises for applicants with chronic medical conditions, disabilities, developmental disorders, psychiatric conditions, or high-cost medication needs. It is not a reflection of the applicant’s worth or character but a technical financial assessment based on projected 5- to 10-year costs. The legal standard requires balancing IRCC cost estimates, provincial health coverage parameters, and realistic private-care arrangements. The outcome of an excessive demand finding can determine whether an entire family obtains permanent residence, since dependent inadmissibility impacts the whole application.

The Legal Test for Excessive Demand

An applicant is inadmissible under IRPA s.38(1)(c) if their medical condition is anticipated to:

• require health or social services whose projected costs exceed the annual excessive-demand threshold multiplied over five years, or
• require social services that would negatively affect wait times for Canadians.

Excessive demand has two components:

1. Cost-based excessive demand
2. Service-impact excessive demand

Most cases involve cost-based determinations.

Cost Threshold

IRCC recalculates the excessive demand cost threshold annually based on average per-capita public spending on health and social services. This threshold applies to a fixed period (typically five years but may be extended for chronic conditions).

If an applicant’s expected treatment or support costs exceed the threshold, a PFL is issued.

Conditions Commonly Triggering Excessive Demand Concerns

• HIV (depending on treatment regimen)
• Chronic renal failure
• Autoimmune disorders requiring biologics
• Developmental disabilities (Down syndrome, ASD)
• Intellectual disabilities
• Severe mental health disorders requiring long-term care
• Organ transplant aftercare
• Cerebral palsy
• Multiple sclerosis
• Speech, occupational, and behavioral therapy needs

IRCC’s Obligations: Individualized Assessment

Key Federal Court decisions require IRCC to:

• evaluate the applicant’s specific circumstances,
• consider proposed mitigation strategies,
• avoid reliance on generic cost assumptions,
• assess evidence from treating physicians and specialists.

A failure to conduct an individualized assessment may render the decision unreasonable.

The Procedural Fairness Letter (PFL)

Before refusing an application, IRCC must issue a PFL detailing:

• the medical condition identified,
• the expected course of treatment,
• cost projections,
• social service requirements,
• duration of anticipated costs.

The PFL is the most critical stage. A well-prepared response often determines the final result.

Key Components of a Strong PFL Response

1. Medical Specialist Reports

Reports should include:

• diagnosis,
• prognosis,
• treatment plans,
• frequency of follow-ups,
• medication regimen and cost,
• impact of the condition on functionality,
• private care options.

2. Cost Mitigation Plan (CMP)

This is the centerpiece of an excessive-demand response. A CMP may include:

• private insurance coverage,
• self-funded home care or therapies,
• in-family support arrangements,
• private medication supply (importation or foreign purchase where legal),
• private schooling for special-needs dependents,
• non-government funded community programs.

IRCC must consider CMPs even if the applicant may theoretically access public services.

3. Cost Tables and Budgeting Analysis

Submit detailed cost breakdowns including:

• annual cost of medication,
• therapy costs (OT, PT, ABA, etc.),
• private rehabilitation services,
• special education fees.

Every cost entry must include verifiable sources.

4. Supporting Affidavits

• from family members regarding caregiving support,
• from applicants regarding financial capacity,
• from employers for private insurance coverage.

5. Legal Submissions

Counsel must apply:

• IRPA s.38(1)(c),
• case law on individualized assessments,
• policy manuals (e.g., OP 15),
• principles of fairness and reasonableness.

Legal analysis ties all evidence together.

Types of Medical Conditions and Strategic Responses

1. Developmental Disabilities (Down Syndrome, ASD)

These cases often involve projected social-service costs. Strategies include:

• private ABA therapy arrangements,
• private speech/occupational therapy,
• proof that school support will be privately funded,
• demonstrating high caregiver involvement.

2. Chronic Medical Conditions (HIV, renal disease)

Strategies include:

• private medication expense coverage,
• evidence of stable health and adherence,
• updated lab results showing good control,
• Canadian physician’s cost estimates.

3. Psychiatric Conditions

These may require:

• expert psychiatric reports,
• evidence of stability,
• private therapeutic arrangements,
• clear crisis-management plan.

Excessive Demand Does NOT Apply to Temporary Residents

Visitors, workers, and students cannot be found inadmissible for excessive demand. However, they can still trigger public-health or public-safety concerns.

Judicial Review: Challenging Excessive Demand Findings

Judicial review may be appropriate when IRCC:

• ignores the applicant’s mitigation plan,
• miscalculates costs,
• fails to conduct individualized analysis,
• misinterprets medical evidence,
• issues a PFL with vague or generic allegations,
• fails to consider updated medical evidence.

Federal Court often overturns excessive demand refusals based on procedural fairness breaches or unreasonable analysis.

Strategic Considerations

Effective representation requires:

• early engagement with medical specialists,
• building a robust mitigation plan,
• accurate cost projections,
• documenting private care commitments,
• comprehensive legal submissions,
• following Federal Court jurisprudence closely.

Families should never attempt excessive-demand PFL responses without legal and medical professional input.

The Role of Skilled Counsel

Excessive-demand cases demand:

• deep knowledge of IRPA and regulations,
• expertise in medical-legal interface,
• coordination with specialists and healthcare providers,
• cost-analysis expertise,
• precise legal drafting.

A well-prepared excessive-demand response can transform a potential refusal into an approval, allowing clients and their families to secure permanent residence in Canada despite serious medical challenges.