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Reason for PR application rejection on medical grounds

salem10

Hero Member
Jul 6, 2010
438
75
Ontario, since 2006
Visa Office......
Buffalo
NOC Code......
0711/4131/4121
Pre-Assessed..
Yes
App. Filed.......
10-05-2010
Doc's Request.
Nov 02, 2010
AOR Received.
May 19, 2011 from buffalo
IELTS Request
submitted writtin sample (accepted)
Med's Request
April 14, 2012
Med's Done....
June 10, 2011, again in May 02, 2012 -medical furtherance June29-2012
Interview........
waived
Passport Req..
Waiting
VISA ISSUED...
Waiting
LANDED..........
20-06-2015
alexure said:
Hi, today after a waiting period of more than 2 months I received a fairness letter. I hope that the response that I'll prepare with attorney's assistant will help me. :(
Wishes the best for you.

From my side, I still waiting since my submission of fairness letter on Oct 10, 2013. No answer, no update expect call from my case officer on Dec 30 at 8:00am. She called me and asked do you want my reply to be assessed!!!. I ordered my file notes, and found she only asked for medical review of my file on Jan 02.
and I noticed my medical validity was extended to May 2014 for the rest of my family members.
 

alexure

Full Member
Dec 18, 2013
32
0
Category........
Visa Office......
Israel
Job Offer........
Pre-Assessed..
Nomination.....
06-Sep-2012
File Transfer...
27-Dec-2012
Med's Request
01-Nov-2013
Med's Done....
07-Nov-2013
Passport Req..
13-May-2014 (06-March-2014 Fairness letter received, 08-May-2014 Response submitted)
VISA ISSUED...
20-May-2014
LANDED..........
14-July-2014
Dear Salem10, I wish you a good luck.

Did you wrote your response to a fairness letter by yourself or you used attorney services?
 

salem10

Hero Member
Jul 6, 2010
438
75
Ontario, since 2006
Visa Office......
Buffalo
NOC Code......
0711/4131/4121
Pre-Assessed..
Yes
App. Filed.......
10-05-2010
Doc's Request.
Nov 02, 2010
AOR Received.
May 19, 2011 from buffalo
IELTS Request
submitted writtin sample (accepted)
Med's Request
April 14, 2012
Med's Done....
June 10, 2011, again in May 02, 2012 -medical furtherance June29-2012
Interview........
waived
Passport Req..
Waiting
VISA ISSUED...
Waiting
LANDED..........
20-06-2015
alexure said:
Dear Salem10, I wish you a good luck.

Did you wrote your response to a fairness letter by yourself or you used attorney services?
Yes, I wrote it by myself. I saw "Computergeek" wrote good notes to you.
 

alexure

Full Member
Dec 18, 2013
32
0
Category........
Visa Office......
Israel
Job Offer........
Pre-Assessed..
Nomination.....
06-Sep-2012
File Transfer...
27-Dec-2012
Med's Request
01-Nov-2013
Med's Done....
07-Nov-2013
Passport Req..
13-May-2014 (06-March-2014 Fairness letter received, 08-May-2014 Response submitted)
VISA ISSUED...
20-May-2014
LANDED..........
14-July-2014
Hi, I hired an attorney who will respond to fairness letter. I cross fingers.
 

computergeek

VIP Member
Jan 31, 2012
5,143
278
124
Vancouver BC
Category........
Visa Office......
CPP-O/LA
Job Offer........
Pre-Assessed..
App. Filed.......
06-03-2012
AOR Received.
21-06-2012
File Transfer...
21-6-2012
Med's Done....
11-02-2012
Interview........
Waived
Passport Req..
26-09-2012
VISA ISSUED...
10-10-2012
LANDED..........
13-10-2012
alexure said:
Hi, I hired an attorney who will respond to fairness letter. I cross fingers.
A good attorney will lay the ground for challenging a refusal should you choose to do so. Of course, laying out a solid case is critical to the process and that just helps focus on ensuring success.

Fair warning: fairness responses can take 6+ months for them to process. They definitely do not prioritize them.
 

alexure

Full Member
Dec 18, 2013
32
0
Category........
Visa Office......
Israel
Job Offer........
Pre-Assessed..
Nomination.....
06-Sep-2012
File Transfer...
27-Dec-2012
Med's Request
01-Nov-2013
Med's Done....
07-Nov-2013
Passport Req..
13-May-2014 (06-March-2014 Fairness letter received, 08-May-2014 Response submitted)
VISA ISSUED...
20-May-2014
LANDED..........
14-July-2014
computergeek said:
A good attorney will lay the ground for challenging a refusal should you choose to do so. Of course, laying out a solid case is critical to the process and that just helps focus on ensuring success.

Fair warning: fairness responses can take 6+ months for them to process. They definitely do not prioritize them.
If the response will be successful , and if CIC will finalize the case after it will be more than 1 year after we underwent the medicals , is it mean that we have to undergo the meds again?
 

salem10

Hero Member
Jul 6, 2010
438
75
Ontario, since 2006
Visa Office......
Buffalo
NOC Code......
0711/4131/4121
Pre-Assessed..
Yes
App. Filed.......
10-05-2010
Doc's Request.
Nov 02, 2010
AOR Received.
May 19, 2011 from buffalo
IELTS Request
submitted writtin sample (accepted)
Med's Request
April 14, 2012
Med's Done....
June 10, 2011, again in May 02, 2012 -medical furtherance June29-2012
Interview........
waived
Passport Req..
Waiting
VISA ISSUED...
Waiting
LANDED..........
20-06-2015
alexure said:
If the response will be successful , and if CIC will finalize the case after it will be more than 1 year after we underwent the medicals , is it mean that we have to undergo the meds again?
I did my last medical in June 2012. Notes on my file indicates that they renewed my medical for a year. Now my medical expires in May 2014. Many people on this forum get their medical extended for one year, specifically those delayed due to Buffalo closure.
 

OhCanadiana

VIP Member
Feb 27, 2010
3,086
217
Job Offer........
Pre-Assessed..
alexure said:
If the response will be successful , and if CIC will finalize the case after it will be more than 1 year after we underwent the medicals , is it mean that we have to undergo the meds again?
If they complete processing and are ready to approve a PR application within 15 months of the date of the original medical exam, with the only exception being the expired medicals, they can extend the medical expiration date.

You can see the details at http://www.cic.gc.ca/english/resources/manuals/bulletins/2012/ob423.asp.
 

salem10

Hero Member
Jul 6, 2010
438
75
Ontario, since 2006
Visa Office......
Buffalo
NOC Code......
0711/4131/4121
Pre-Assessed..
Yes
App. Filed.......
10-05-2010
Doc's Request.
Nov 02, 2010
AOR Received.
May 19, 2011 from buffalo
IELTS Request
submitted writtin sample (accepted)
Med's Request
April 14, 2012
Med's Done....
June 10, 2011, again in May 02, 2012 -medical furtherance June29-2012
Interview........
waived
Passport Req..
Waiting
VISA ISSUED...
Waiting
LANDED..........
20-06-2015
OhCanadiana said:
If they complete processing and are ready to approve a PR application within 15 months of the date of the original medical exam, with the only exception being the expired medicals, they can extend the medical expiration date.

You can see the details at http://www.cic.gc.ca/english/resources/manuals/bulletins/2012/ob423.asp.
Not accurate at least for all cases. I said they renewed my medical for full year. I did medical on June 2012, and now it expires in May 2014. I can see the request or medical renewal sent by case officer to the medical center and it was extended for one year. I am still waiting for ppr.
 

OhCanadiana

VIP Member
Feb 27, 2010
3,086
217
Job Offer........
Pre-Assessed..
salem10 said:
Not accurate at least for all cases. I said they renewed my medical for full year. I did medical on June 2012, and now it expires in May 2014. I can see the request or medical renewal sent by case officer to the medical center and it was extended for one year. I am still waiting for ppr.
Can you please elaborate? Not sure what your point is.

To elaborate on my side (and hopefully to put alexure's mind at ease), the point I was making is that it is possible to extend medical exam expiration dates and that, in fact, it is standard procedure (since May 2012) to extend the medical exams for 12 months as long as the original medical exam was performed within 15 months of the date the visa officer requests the extension.
 

alexure

Full Member
Dec 18, 2013
32
0
Category........
Visa Office......
Israel
Job Offer........
Pre-Assessed..
Nomination.....
06-Sep-2012
File Transfer...
27-Dec-2012
Med's Request
01-Nov-2013
Med's Done....
07-Nov-2013
Passport Req..
13-May-2014 (06-March-2014 Fairness letter received, 08-May-2014 Response submitted)
VISA ISSUED...
20-May-2014
LANDED..........
14-July-2014
This is the letter that I received from the embassy:

Dear Mr.,

I am now completing the assessment of your application for a permanent resident visa. It appears that you may not meet the requirements for immigration to Canada.


Pursuant to subsection 38(1) of the Immigration and Refugee Protection Act, a medical officer has concluded that your dependent, , is a person whose health condition might reasonably be expected to cause excessive demand on health or social services. The regulatory definitions of these terms are attached.

The medical officer has determined that your dependent, has the following medical condition or Diagnosis: Heart-Congenital Anomaly (746).

Narrative:

This 2.4 year old child has a congenital pulmonic stenosis. He underwent initial repair at the age of 5 months, consisting of pulmonary balloon valvotomy at the Medical Center . After the procedure, the gradient on the pulmonary valve went down from 72 mmHg to 37 mmHg. The consulting cardiologist, Dr , wrote in his December 2013 report: “Currently his pulmonic valve suffers from mild-moderate stenosis, with good functioning of the right ventricle. In the future (possibly within the next few years) he may need another valvotomy to repair the pulmonic valve. He continues to be followed up biannually by a paediatric cardiologist and should be continued to be followed in the same fashion.”



The prognosis of medical condition is for continuation and probably deterioration. As stated by the treating cardiologist, will need a follow up by a paediatric cardiologist. He will probably require a new cardiovascular procedure to treat the stenosis of his pulmonary valve. If this procedure cannot be done by a percutaneous method, open heart cardiac surgery will be required to replace the stenotic valve and prevent further complications. This will have to be done in a specialized center for cardiac paediatric surgery with access to an intensive care unit. These assessments and treatments require specialists in cardiology and cardiovascular surgery, and the utilization of specialized tertiary hospital-based resources which are expensive, publicly funded and in high demand.


Based upon my review of the results of this medical examination and all the reports I have received with respect to health condition, I conclude that he has a health condition that might reasonably be expected to cause excessive demand on health services. Specifically, this medical condition might reasonably be expected to require health services, the costs of which would likely exceed the average Canadian per capita costs over a five year period and would add to existing waiting lists for these services, thus delaying their provision to those in Canada who need them, impacting unfavourably on morbidity and mortality related to heart conditions. is therefore deemed inadmissible under Section 38(1)(c) of the Immigration and Refugee Protection Act.


Before I make a final decision, you may submit additional information relating to this medical condition or diagnosis. You may also submit any information addressing the issue of excessive demand if it applies to your case. You have until May 10, 2014 to submit additional information to our office. Please ensure that you quote the file number indicated at the top of this letter on any information you submit.


You are responsible for any fees charged by doctors or other professionals you consult as a result of this opportunity to submit new information. You must provide any additional information within sixty days from the date of this letter. If you choose not to respond with additional information, I will make a decision based on the information before me which may result in the refusal of your application.


I look forward to receiving your additional information.


Sincerely,


Immigration & Visa Section

Canadian Embassy
 

computergeek

VIP Member
Jan 31, 2012
5,143
278
124
Vancouver BC
Category........
Visa Office......
CPP-O/LA
Job Offer........
Pre-Assessed..
App. Filed.......
06-03-2012
AOR Received.
21-06-2012
File Transfer...
21-6-2012
Med's Done....
11-02-2012
Interview........
Waived
Passport Req..
26-09-2012
VISA ISSUED...
10-10-2012
LANDED..........
13-10-2012
This is a "fairness letter". It is defective in that it does not actually provide you with estimated costs. Further, it makes a guess as to "possible future costs" and just asserts such costs are expensive. This does not meet the requirements laid out in OP 15, but in my personal experience is typical of CIC's responses.

To rebut this, you would need some sort of letter from a qualified physician stating that it is "unlikely" (or "exceedingly unlikely") that the child will require open heart surgery, as that seems to be the primary concern with respect to cost. If you are proposing landing in BC or AB, you could offer to opt out of the public funded health care system (most provinces do not permit this, but BC and AB both do). Of course, then the child will be without health care.

Beyond that, you can present counter-arguments. For example, you could argue that the model of evaluation is incorrect (because the officer rejects the entire group, but does not spread the costs out over the entire group of potential immigrants - a sort of "reverse cherry picking" as it were). You could also argue that Canada's signing of the UN Convention on the Rights of Persons with Disabilities supersedes IRPA (because it was signed after IRPA was passed into law) - http://www.un.org/disabilities/convention/conventionfull.shtml. Of course, you'd have to explain how the officer's decision would violate that accord.

Here's an excellent brochure (http://www.cashra.ca/documents/CASHRA-CRDP-brochure_accessible.pdf) published by Ontario on the impact of Canada's signing of this convention. Note that it provides special protections for children with disabilities as well.

I think I'd argue that Article 25 (which prohibits discrimination in "health insurance" for persons with disabilities) would bear directly on this issue.

Fair warning: I don't expect either of these two arguments to convince an officer. However, by presenting the arguments you would lay the groundwork for a very interesting Judicial Review application.

My advice is that you should find a very good attorney that specializes in excessive demand medical inadmissibility cases if it's at all possible. There are only a handful of such lawyers (I can provide names via PM if you would like). You should also be asking for more time to respond to the fairness letter, as well as speaking to your physician to gauge the realistic likelihood of the need for open heart cardiac surgery in the 5-10 year future.
 

alexure

Full Member
Dec 18, 2013
32
0
Category........
Visa Office......
Israel
Job Offer........
Pre-Assessed..
Nomination.....
06-Sep-2012
File Transfer...
27-Dec-2012
Med's Request
01-Nov-2013
Med's Done....
07-Nov-2013
Passport Req..
13-May-2014 (06-March-2014 Fairness letter received, 08-May-2014 Response submitted)
VISA ISSUED...
20-May-2014
LANDED..........
14-July-2014
Hi, I already have an attorney. I hired attorney which you used in your case. Thank you very much for your explanations.
 

computergeek

VIP Member
Jan 31, 2012
5,143
278
124
Vancouver BC
Category........
Visa Office......
CPP-O/LA
Job Offer........
Pre-Assessed..
App. Filed.......
06-03-2012
AOR Received.
21-06-2012
File Transfer...
21-6-2012
Med's Done....
11-02-2012
Interview........
Waived
Passport Req..
26-09-2012
VISA ISSUED...
10-10-2012
LANDED..........
13-10-2012
alexure said:
Hi, I already have an attorney. I hired attorney which you used in your case. Thank you very much for your explanations.
Good. I'm sure he will do a good job on your behalf. He knows how to respond to maximize the chance that CIC won't reject and to lay out a solid case if they do so. I'm not sure if he's considered the UN Convention argument yet, or not, but in your case I suspect you can beat the fairness issue without going to Federal Court (though if you do, you have one of the two attorneys I'd recommend for it - they have excellent track records for these cases against CIC.)
 

alexure

Full Member
Dec 18, 2013
32
0
Category........
Visa Office......
Israel
Job Offer........
Pre-Assessed..
Nomination.....
06-Sep-2012
File Transfer...
27-Dec-2012
Med's Request
01-Nov-2013
Med's Done....
07-Nov-2013
Passport Req..
13-May-2014 (06-March-2014 Fairness letter received, 08-May-2014 Response submitted)
VISA ISSUED...
20-May-2014
LANDED..........
14-July-2014
computergeek said:
Good. I'm sure he will do a good job on your behalf. He knows how to respond to maximize the chance that CIC won't reject and to lay out a solid case if they do so. I'm not sure if he's considered the UN Convention argument yet, or not, but in your case I suspect you can beat the fairness issue without going to Federal Court (though if you do, you have one of the two attorneys I'd recommend for it - they have excellent track records for these cases against CIC.)
Thanks. I hope you are right and I'll be lucky.