Medical Inadmissibility to Canada: Excessive Demand and Your Options

The three grounds in section 38

Section 38(1) of the Act says a foreign national is inadmissible on health grounds if their health condition:

• is likely to be a danger to public health, for example an untreated infectious disease such as active tuberculosis;
• is likely to be a danger to public safety, for example a condition that could reasonably lead to unpredictable or violent behaviour or sudden incapacity; or
• might reasonably be expected to cause excessive demand on health or social services.

Most refusals involve the third ground. Section 1(1) of the Regulations defines "excessive demand" in two ways: (a) a demand on health or social services for which the anticipated costs exceed triple the average Canadian per capita health services and social services costs over five consecutive years following the most recent medical examination; or (b) a demand that would add to existing waiting lists and would increase morbidity or the mortality rate in Canada because of an inability to provide timely services to Canadian citizens or permanent residents. IRCC updates the dollar figure for the cost threshold each year, most recently in January 2026, so check IRCC's current figure rather than relying on an old number.

Who is exempt from the excessive demand ground

Section 38(2) of the Act says the excessive demand ground does not apply to a foreign national who has been determined to be a member of the family class and the spouse, common-law partner or child of a sponsor; who applied for a permanent resident visa as a Convention refugee or a person in similar circumstances; or who is a protected person. In prescribed cases, certain family members of those persons are also exempt.

The danger to public health and danger to public safety grounds still apply to these groups. If you or a family member might fall in an exempt category, say so in your application and in any response to IRCC. Our page on spousal and family sponsorship explains the sponsorship rules.

The medical exam and what happens next

An officer can require an applicant to undergo a medical examination (section 16(2)(b) of the Act). The examination is done by a panel physician approved by IRCC, and the results go to an IRCC medical officer, who writes an opinion. If the medical officer thinks the person may be inadmissible, IRCC usually sends a procedural fairness letter before making a final decision. The letter explains the concern and gives a deadline to respond, and the response is often the applicant's main chance to change the outcome.

What a strong response can include

• Current medical records and a report from the treating specialist, describing the condition, treatment and expected course.
• Evidence that the person's needs can be met without relying on publicly funded services, such as private insurance, the person's own funds, or services that would be privately arranged.
• A mitigation plan or declaration explaining how costs will be covered and that the person is able and willing to carry out the plan.
• Where the medical officer has relied on a cost estimate, an analysis of whether the services identified are actually needed and publicly funded in the place where the person will live.
• Evidence that a child's or family member's needs are different from those assumed, or that the person falls into an exempt category.

The response should be organised, consistent with the earlier application, and supported by documents. Do not submit anything you cannot verify. See our page on procedural fairness letters.

If the application is refused

A refusal for medical inadmissibility is not always the end. Options may include reapplying with a fuller mitigation plan if the facts or the person's condition have changed, asking for the file notes, and applying to the Federal Court for leave to commence judicial review. The Court looks at whether the decision was lawful and reasonable and does not make a new decision. Under section 72(2)(b) of the Act, the application must be filed within 15 days for a matter arising in Canada or within 60 days for a matter arising outside Canada. See what to do after a refusal.

In some cases a temporary resident permit or a humanitarian and compassionate request may also be available, but these have their own rules and are discretionary. See temporary resident permits.

Mistakes to avoid

• Leaving a condition off the medical forms. Misrepresentation under section 40 can lead to five years of inadmissibility.
• Responding after the deadline, or responding without medical evidence.
• Assuming a refusal for one family member does not affect the rest of the application. Section 42 of the Act can make a family inadmissible because of an accompanying family member.
• Treating a refusal for a temporary visa as the same as a refusal for permanent residence. The rules and exemptions can differ.

How we can help

We review the medical refusal or procedural fairness letter, explain how the exemptions in section 38(2) apply, help gather medical and financial evidence, prepare the response, and represent clients in Federal Court where appropriate. We meet clients in English, Urdu, Hindi and Punjabi. We cannot promise a particular outcome.