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Help me with Procedural Fairness Reply regarding the Medical Inadmissibility

Discussion in 'Canadian Experience Class' started by Unforgiveniiii, Dec 6, 2017.

  1. Hi,
    I applied for Express Entry under CEC class on June 2017. Currently I live in Manitoba. Recently I got a procedural fairness letter from CIC regarding my health. My all other things have been passed. The reason is I am having an injection call Humira which was suggested by my doctor as a trial for a year. Its yearly cost is 20000 cad which is currently funded by the provincial government (pharmacare).
    Here is the letter from CIC:

    Dear “X”:
    This letter concerns your application for permanent residence in Canada. Based on a review of your file,
    it appears that you or your family member may not meet the requirements for immigration to Canada.
    I have determined that you are a person whose health condition might reasonably be expected to cause
    excessive demand on health or social services in Canada. An excessive demand is a demand for which
    the anticipated costs exceed the average Canadian per capita health and social services costs, which is
    currently set at $6,655 per year. Pursuant to subsection 38(1) of the Immigration and Refugee Protection
    Act, it therefore appears that you may be inadmissible on health grounds.
    You, “X”, have the following medical condition or diagnosis: Ankylosing Spondylitis.
    In particular:
    The applicant has a diagnosis of ankylosing spondylitis. The diagnosis was confirmed based on
    all information gathered.
    This 26 year old man has applied to immigrate to Canada in an economic class category (CEC),
    his intended province of destination is Manitoba. The applicant has longstanding ankylosing
    spondylitis, an inflammatory arthritis with no known cure. The applicant was assessed by a
    Rheumatology Specialist in March 2017, who confirmed that his ankylosing spondylitis is
    reasonably controlled and he is to start the medication Humira shortly following completion of
    treatment for latent tuberculosis. The dosage is 40 mg every two weeks.
    Specifically the client has ankylosing spondylitis that might reasonably lead to his requiring
    ongoing treatment with the biologic medication Humira, the cost of which would likely exceed
    the average Canadian per capita costs over 5 years. The required health services are costly and
    publicly funded.
    Source of Information:
    http://www.gov.mb.ca/health/pharmacare/profdocs/dhcd.pdf
    Date Accessed: November 29, 2017

    Other Information:
    The expected cost for health related services for this applicant is $20,818.20 per year over 5
    YEARS. 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.”
    Medical Officer - Immigration, Refugees and Citizenship Canada (IRCC)
    Appendix I: Expected Costs of Services
    Medication
    The cost of Humira 40 mg every two weeks is $800.70 or $20,818.20 per year in Manitoba.
    Source of Information:
    http://www.gov.mb.ca/health/pharmacare/profdocs/dhcd.pdf
    Date Accessed: November 29, 2017
    TOTAL COST OF ALL LISTED SERVICES: $20,818.20 per year
    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 February 5, 2018. Please upload these documents to
    your MyCIC account. If you choose not to respond, I will make my decision based on the information
    before me, which may result in your application being refused.

    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.
    ****IMPORTANT INSTRUCTIONS****
    Please ensure that you provide one response that contains all of the supporting documents you wish
    to submit. Include a detailed list of every supporting document that:

    a. describes the type of document
    b. includes how many pages are in the document
    c. includes the date of the document

    For example: “Lab report, 3 pages, dated February 25, 2016”
    Please ensure that you quote the file number indicated at the top of this letter on any information you
    submit.
    Please note:
    • Any documents submitted which are not in English or French must be accompanied by a notarized
    translation in either English or French.
    • Do not submit originals, unless otherwise stated, as documents submitted will not be returned.
    • Please note that we can only accept unzipped PDF, JPG or .doc files that are attached to an email,
    totaling less than 5 MB.
    Sincerely,
    AK8334
    Immigration, Refugees and Citizenship Canada | Immigration, Réfugiés et Citoyenneté Canada
    Government of Canada | Gouvernement du Canada



    Now I need help on writing the procedural fairness response which I did not find a sample online.
    My current plan includes:
    1. Ask doctor to change the medicine if possible, because it was a trial. I believe this is not mandatory for my treatment.
    2. I have my private insurance, which cover 80% of the cost. If it pays 80% still I have to pay 325 cad per month which I believe I can manage from my salary.
    3. I have asked help from a private organization as well if they can help me
    4. I have my continuing full time job and savings of almost 27K which I am going to show.
    5. Can I show my parents fund as well if they agree to support in case needed. They will be able to show the overall cost for 5 years that they can bear (more than 100K CAD)

    Kindly help me regarding the letter and if you think the plan is good enough to manage the officer.
     
  2. 1. This is the best course of action - but you need to change you medication before you sent the fairness letter response. In your fairness letter, you should include a letter from your doctor indicating what medication you've switched to and how much it costs in Canada (it must be less than $6,600 per year).
    2. Are you 100% sure your private insurance will cover the medication? Private medication often doesn't cover this kind of medication. You'll need a letter from your insurer confirming they will cover the costs of this medication indefinitely. Before you send the fairness letter, you should also stop getting the provincial health care system to pay for your medication and start having your private insurance cover the costs.
    3. This isn't a strong argument since there's nothing stopping you from using the provincial system once you are a PR.
    4. This won't help. That will only cover the medication for one year and once you are a PR, there's nothing stopping you from using the provincial system.
    5. Same as above. Nothing stopping you from using the provincial system once you are a PR.
     
  3. Hi Thanks for the wonderful response. I talked with my insurance company. THey will cover 80% according to the group insurance policy. I called them twice. Currently they are the second insurer, first is pharmacare which is govt. The reason I am showing for 5 years is, the visa officer wants to know a detail plan for a period of 5 years. The reason why I am trying to show my parents fund is, if somehow they think that i can lose my job within this 5 years means i will lose my insurance. In that case still I have fund which will cut the risk of excessive demand to the canadian government. I already talked with my nurse regarding the change of medication. He will let me know if the doctor approves.
     
  4. You'll need to get it in writing from your group insurance policy that they are willing to be the primary insurer and cover 80% of the total cost of the medication - and then include this as evidence in your response.
     
    jes_ON likes this.
  5. Thanks. Do you by chance have any sort of sample letter? I would like to see a sample response or template.
     
  6. You should be working with a lawyer experienced with excessive demand cases, to help you draft the letter.

    The problem with all of these alternatives you're proposing (private insurance, your own savings, parents savings, etc), is there there is no legal obligation on your part to follow through with any of it. Once you're a PR, you can dump all of that and simply jump onto the provincial healthcare system to fund everything, as all PRs have a fundamental right to access healthcare in Canada if they wish.

    The visa officers know this, so in many cases they will not put much weight into these kinds of plans as they may just be empty promises. Often a better course of action is to challenge the costs from the visa officer, and show perhaps the expected costs would be lower with your own research.

    Really though, for best chance of success here get a lawyer with some proven successes with these fairness letters.
     
  7. No - I don't. Agreed with the recommendation above - you should be working with a very good immigration lawyer at this point to put together a response.

    A fairness letter means that CIC plans to refuse you. It's your last chance to convince them otherwise.
     

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