Received Fairness Letter......Seeking guidance for reply

[RPAL]

same advise for you, my friend = RELAX
you still have long way to go and time to prepare everything, so calm down and don't get tense. you might get your visa right away without any trouble. be positive
do you need a lawyer? i don't think it is necessary at this point especially you haven't even received medical request yet. your lawyer will start charging as soon as you signed an agreement with them and they can not guarantee any success 8) (no offense to all the lawyers here).
same as my previous post, figure out the details of your need, then find them all through google, lots of information there.

did you show your financial balance / strength (like CAD 30000 or something) before receiving the fairness letter?
yes of coz, it is part of the visa application forms. and you will need to show the update list when you reply the fairness letter.

anyway, if you have the money but not the time, surely having a lawyer is very helpful because they have experiences in how to handle similar cases. But remember, they can not guarantee that their service will be successful but at least they have more resources.
best of luck
cheers

Thanks for your reply. Yeh, It was too fast from me. I forgot to be positive. Yes, you right, google has a lot of information. RELAX RELAX.
Thanks again.

 

[Thankyougod]

Dear All,

I am here to share my story for anyone who might need guidance. When I went through this medical issue I just had no idea where to look. We applied for few in 2014, got per in march 2015 and then there was a long silence. During this wait in Feb 2016, my husband was diagnosed with testicular cancer stage 1. He went through the operation and chemo and I was almost certain we will receive fairness letter. On this forum I keep looking for threads with a similar medical condition but didn't find anything. I did send email to @computergreek and he was extremely helpful. He indicated that if my husband has been treated in all probability he is within the medical threshold and should not get fairness letter. We received MR in Aug and once we declared the cancer, we were asked to go to a panel oncologist for a detailed report. The doctor did additional blood tests and XRAY and gave us the report that he is fine and only needs to be on follow up. Once this letter was scanned in 2 days we received PR email and status has been changed to decision made.

I am extremely thankful to computergreek for the advise and want to leave this post for others who come looking for more info like I did. Wishing all of you success with your PR applications.

 

[tosinosho1992]

Dear All,

I am here to share my story for anyone who might need guidance. When I went through this medical issue I just had no idea where to look. We applied for few in 2014, got per in march 2015 and then there was a long silence. During this wait in Feb 2016, my husband was diagnosed with testicular cancer stage 1. He went through the operation and chemo and I was almost certain we will receive fairness letter. On this forum I keep looking for threads with a similar medical condition but didn't find anything. I did send email to @computergreek and he was extremely helpful. He indicated that if my husband has been treated in all probability he is within the medical threshold and should not get fairness letter. We received MR in Aug and once we declared the cancer, we were asked to go to a panel oncologist for a detailed report. The doctor did additional blood tests and XRAY and gave us the report that he is fine and only needs to be on follow up. Once this letter was scanned in 2 days we received PR email and status has been changed to decision made.

Congrats,

Is your husband on medications and did you apply in Canada? Thanks.
I am extremely thankful to computergreek for the advise and want to leave this post for others who come looking for more info like I did. Wishing all of you success with your PR applications.

 

[NewPlan2014]

Dear All,

I am here to share my story for anyone who might need guidance. When I went through this medical issue I just had no idea where to look. We applied for few in 2014, got per in march 2015 and then there was a long silence. During this wait in Feb 2016, my husband was diagnosed with testicular cancer stage 1. He went through the operation and chemo and I was almost certain we will receive fairness letter. On this forum I keep looking for threads with a similar medical condition but didn't find anything. I did send email to @computergreek and he was extremely helpful. He indicated that if my husband has been treated in all probability he is within the medical threshold and should not get fairness letter. We received MR in Aug and once we declared the cancer, we were asked to go to a panel oncologist for a detailed report. The doctor did additional blood tests and XRAY and gave us the report that he is fine and only needs to be on follow up. Once this letter was scanned in 2 days we received PR email and status has been changed to decision made.

I am extremely thankful to computergreek for the advise and want to leave this post for others who come looking for more info like I did. Wishing all of you success with your PR applications.

CONGRATULATION

 

[reeps_du]

Dear All members
Thanks to all member of this group for helping people. Now a am in need of your support. Please please please help.

I have applied for immigration under FSW category. Now in the process I have received a fairness letter. My family member (4 year child) is having developmental delay. On this criteria they are saying that she might need a. individual special education plan b. speech therapy c. occupational therapy. They also sy that she may place an excessive demand on educational services when compare to their baseline education needs and funding for the average student.

Now they are asking for additional information on a. The medical conditions identified. b. social services required in canada for the period indicated above (but no time period mention in letter?) c. individual plan to ensure that no excessive demand will be impose on Canadian social service. c. my signed declaration of ability and intend.

They also said that I have to domonastrate that I have a reasonable plan along with the financial means and intent to implement this plan.

Please help me how to reply? Please also give me an idea how much financial support required to grow a child with above support? How can I provide a plan that will work? Please help.

Computergreek please reply

 

[Thankyougod]

No medications. I applied from outside canada.

 

[MXIA]

Hello everyone - I've been reading the thread since I received fairness letter two days ago. Everyone in this tread is extremely helpful not to mention Computergeek!!

Here's a copy of my letter:

"You have the following medical condition or diagnosis: Chronic Hepatitis B (HBV) – (070.3). In
particular:
The applicant has a diagnosis of chronic Hepatitis B infection. The diagnosis was confirmed based on all
information gathered.

This 25 year old female presently on a work permit was monitored for HBV in China before moving to
Canada in 2008. When back in China in 2010 she had elevated liver function tests (LFTs) and was started
on Telbivudine which was discontinued because of side-effects. Since then her LFTs have been
increasing indicating increased inflammation of the liver. She has minimal fibrosis and no cirrhosis at
this point in time. She will likely require prolonged treatment with Tenofovir (Viread) to decrease the risk
of cirrhosis, liver cancer and transmission to others.

Specifically, this client has Hepatitis B that might reasonably lead to them requiring prolonged treatment
with expensive medication,the cost of which would likely exceed the average Canadian per capita costs
over five years. The required health services are costly and publicly funded.
Source of Information:
**BC Pharmacare booklet**
Date Accessed: April 04, 2016
Other Information:
The expected cost for health related services for this applicant is $7,537 per year or $$37,685 over five
years plus $1,200/year to cover the cost of blood test, fibroscans and regular visits to the Hepatologist.
This amount exceeds the average per capita threshold of $6,450.00 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.”
Senior Medical Officer - Immigration, Refugees and Citizenship Canada (IRCC)
Appendix I: Expected Costs of Services
Medication(s)
Details of Services: Viread (Tenofovir) daily
$ 7,537 per year
Source of Information:
**Refered to BC Pharmacare booklet link here**
Date Accessed: April 04, 2016
TOTAL COST OF ALL LISTED SERVICES: $8,737 per year or $43,685 for five years "

=======================================================

I'm already under drug treatment for half a year, and my employer group health plan covered 100% of the cost.

I called my nurse and confirmed the cost of my treatment immediately - My current medication costs $750/month. There is cheaper medication which costs $150/mo, but she needs to get DR's approval first. I'm waiting for her response now.

If I am able to get DR's note to suggest that my next 5 years treatment will cost $1800 per year, is it strong enough to overcome medical e inadmissibility? Would Medical officer question my DR's first opinion (treatment of $750/mo drug)?

Should I also provide thorough mitigation plan? The $150 drug is not as effective as the $750 one. I'm not sure how to response in this case.

Please advise - any opinion is appreciated!! Thank you in advance!

 

[tosinosho1992]

Hello everyone - I've been reading the thread since I received fairness letter two days ago. Everyone in this tread is extremely helpful not to mention Computergeek!!

Here's a copy of my letter:

"You have the following medical condition or diagnosis: Chronic Hepatitis B (HBV) – (070.3). In
particular:
The applicant has a diagnosis of chronic Hepatitis B infection. The diagnosis was confirmed based on all
information gathered.

This 25 year old female presently on a work permit was monitored for HBV in China before moving to
Canada in 2008. When back in China in 2010 she had elevated liver function tests (LFTs) and was started
on Telbivudine which was discontinued because of side-effects. Since then her LFTs have been
increasing indicating increased inflammation of the liver. She has minimal fibrosis and no cirrhosis at
this point in time. She will likely require prolonged treatment with Tenofovir (Viread) to decrease the risk
of cirrhosis, liver cancer and transmission to others.

Specifically, this client has Hepatitis B that might reasonably lead to them requiring prolonged treatment
with expensive medication,the cost of which would likely exceed the average Canadian per capita costs
over five years. The required health services are costly and publicly funded.
Source of Information:
**BC Pharmacare booklet**
Date Accessed: April 04, 2016
Other Information:
The expected cost for health related services for this applicant is $7,537 per year or $$37,685 over five
years plus $1,200/year to cover the cost of blood test, fibroscans and regular visits to the Hepatologist.
This amount exceeds the average per capita threshold of $6,450.00 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.”
Senior Medical Officer - Immigration, Refugees and Citizenship Canada (IRCC)
Appendix I: Expected Costs of Services
Medication(s)
Details of Services: Viread (Tenofovir) daily
$ 7,537 per year
Source of Information:
**Refered to BC Pharmacare booklet link here**
Date Accessed: April 04, 2016
TOTAL COST OF ALL LISTED SERVICES: $8,737 per year or $43,685 for five years "

=======================================================

I'm already under drug treatment for half a year, and my employer group health plan covered 100% of the cost.

I called my nurse and confirmed the cost of my treatment immediately - My current medication costs $750/month. There is cheaper medication which costs $150/mo, but she needs to get DR's approval first. I'm waiting for her response now.

If I am able to get DR's note to suggest that my next 5 years treatment will cost $1800 per year, is it strong enough to overcome medical e inadmissibility? Would Medical officer question my DR's first opinion (treatment of $750/mo drug)?

Should I also provide thorough mitigation plan? The $150 drug is not as effective as the $750 one. I'm not sure how to response in this case.

Please advise - any opinion is appreciated!! Thank you in advance!



[/quote
I hurts to know about your medical inadmissibility. I am sure with the help of the Veterans here, you will get to the finish line. I would not recommend opting for a cheaper and less effective treatment for chronic Hepb just to overcome medical inadmissibility; your health and well-being should take priority (you only have one liver). I believe you are better positioned to sail through with your job, insurance coverage etc. A careful and thorough mitigation plan should suffice.
Did the doctor order the following tests: HBV DNA, HBeAg, HBeAB, ALT etc. Do you have a prognosis report from your Hepatologist/gastroenterologist?
Check if the manufacturers of tenofovir offer discounted/free drugs for qualified low income patients.

Good Luck

 

[computergeek]

The expected cost for health related services for this applicant is $7,537 per year or $$37,685 over five
years plus $1,200/year to cover the cost of blood test, fibroscans and regular visits to the Hepatologist.
This amount exceeds the average per capita threshold of $6,450.00 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.”
Senior Medical Officer - Immigration, Refugees and Citizenship Canada (IRCC)
Appendix I: Expected Costs of Services
Medication(s)
Details of Services: Viread (Tenofovir) daily
$ 7,537 per year
Source of Information:
=======================================================

I'm already under drug treatment for half a year, and my employer group health plan covered 100% of the cost.

I called my nurse and confirmed the cost of my treatment immediately - My current medication costs $750/month. There is cheaper medication which costs $150/mo, but she needs to get DR's approval first. I'm waiting for her response now.

If I am able to get DR's note to suggest that my next 5 years treatment will cost $1800 per year, is it strong enough to overcome medical e inadmissibility? Would Medical officer question my DR's first opinion (treatment of $750/mo drug)?

Should I also provide thorough mitigation plan? The $150 drug is not as effective as the $750 one. I'm not sure how to response in this case.

This is a weak analysis on the part of IRCC. Tenofovir loses patent protection next July, at which point the cost is likely to drop substantially (which is why "the other drug" - Lamivudine - is below the threshold. It is now generic.) Thus, the counter-argument to this would be to point out the loss of patent protection (which is public information on the patent drug registry) and show the generic cost of the drug is much lower (e.g., by using www.aidsdrugsonline.com, a Canadian firm that provides generic drug access to patients outside Canada. The site is geo-blocked from inside Canada.)

In addition, BC does not pay 100% of drug costs, so to include that in the calculation is disingenuous - remember, when it comes to medical decisions, IRCC is acting as an agent for the Province (there's a written contract between BC and the Federal Government, in fact.) An agent has an obligation to be aware of their clients procedures when administering them on behalf of the client.

Fair Pharmacare limits coverage based upon income, with a cap of $10,000 per year. A similarly reasonable rebuttal, especially if you are already employed in BC, is to show your income, and the amount not covered by Fair Pharmacare and deduct that from the IRCC number - if it is above $2500 per year, then you fall below the threshold, even with your current treatment.

The $1800 per year cost estimate is grossly overexaggerated as well. If you are already covered by MSP (and it sound like you are) you should order your MSP coverage history - this will list the amounts actually paid. Since you've been under treatment for 6 months, you could use the actual figures to rebut IRCC's position. I suspect you will find the cost is under $1000 - and your first six months are likely to be the most expensive.

Thus, the combination that Tenofovir loses patent status, Fair Pharmacare limitations, actual costs for your routine care, and the fact you have group insurance covering your medication should be more than enough to rebut IRCC's calculation.

This is the norm for IRCC: assert you are excessive demand and push the obligation back upon you to rebut them.

 

[tosinosho1992]

@Computergeek, welcome back. I have had a pressing question on my mind for a while. To avoid getting a procedural fairness letter, is it possible to take all documents/mitigation plan (drug receipts, doctor's report, insurance documents etc) to the panel physician before the medicals? Will all the documents be sent to the MO?

 

[MXIA]

I hurts to know about your medical inadmissibility. I am sure with the help of the Veterans here, you will get to the finish line. I would not recommend opting for a cheaper and less effective treatment for chronic Hepb just to overcome medical inadmissibility; your health and well-being should take priority (you only have one liver). I believe you are better positioned to sail through with your job, insurance coverage etc. A careful and thorough mitigation plan should suffice.
Did the doctor order the following tests: HBV DNA, HBeAg, HBeAB, ALT etc. Do you have a prognosis report from your Hepatologist/gastroenterologist?
Check if the manufacturers of tenofovir offer discounted/free drugs for qualified low income patients.

Good Luck

Hey tosinosho, thanks a bunch for the support. You are right, my wellness should be my priority but not overcoming medical inadmissibility. I will spend the next couple weeks to compose a strong mitigation plan that IRCC can not refuse! I will update in the thread if I get any good news...

This is a weak analysis on the part of IRCC. Tenofovir loses patent protection next July, at which point the cost is likely to drop substantially (which is why "the other drug" - Lamivudine - is below the threshold. It is now generic.) Thus, the counter-argument to this would be to point out the loss of patent protection (which is public information on the patent drug registry) and show the generic cost of the drug is much lower (e.g., by using aidsdrugsonline.com, a Canadian firm that provides generic drug access to patients outside Canada. The site is geo-blocked from inside Canada.)

Computergeek I appreciate every word you say...thank you for reading my case thoroughly and providing such an in-depth and valuable analysis on this!! I will do my research and tackle IRCC from the angles you suggested.

I was not able to find Tenofovir on the site you referred, but I found it under: qualityprescriptiondrugs.com. The price they quoted is $63 USD for 30 tablet, which equals $756/yr...Is this too low? Will IRCC see the website as a reliable source to site?

So my main focus on this should be:
1. Patent on Tenofovir expires July 2017, thus even though first year's expense is $7537 as quoted, the following 4 years will be reduced to $756/yr; with $1200 annual check up fees included, total cost for next 5 year will be $15,361. This is far below the threshold!
2. I'm currently living in Ontario and I'm a Ontario PNP nominee (not sure why they used BC Pharmacare as source of information), I found that my deductible for Trillium Drug Program is approx. $1300/yr. Which sets the cost to government even lower. Or maybe if I should just opt out from the program to show my determination??
3. I should also prove that I'm not going to use government a penny as I'm covered by employer group plan. They've paid in the past and will continue to cover my future costs.

Does this sound strong enough Computergeek? Thank you again for your guidance!

 

[computergeek]

In the Companioni decision, the court said that IRCC must consider insurance in doing their calculation. Because you have an in-place policy that is already covering some portion of the cost, IRCC must consider that.

In your response you should point to the insurance, provide evidence (e.g., via an explanation of benefits, often found on their web portal, sometimes mailed to you via mail, depending upon the insurance company) that it is already paying part of the cost. Also include the Trillium drug evidence that you cited. The cost evidence you provided as a basis for the cost of generic tenofovir should also be included. The combination should be more than enough to overcome this objection. If they refuse you still, then you would have a good case in Federal Court.

Good luck!

 

[G_Singh84]

Did you got any update. I might fall under the same situation. What was the outcome. Hope everything went well.

 

[anlindsey]

Hello everyone - I've been reading the thread since I received fairness letter two days ago. Everyone in this tread is extremely helpful not to mention Computergeek!!

Here's a copy of my letter:

"You have the following medical condition or diagnosis: Chronic Hepatitis B (HBV) – (070.3). In
particular:
The applicant has a diagnosis of chronic Hepatitis B infection. The diagnosis was confirmed based on all
information gathered.

We're on the same boat though I have not received a fairness letter because I'm still on medical furtherance.I need to submit again my laboratory results after oct.7. I emailed GILEAD and they have a program in Canada it is called HEPSTART.they provide financial aid for VIREAD user.They give 1200cad/year.You just have to call to enroll (1-866-949-9920) if you are in Canada. Tenofovir will expire on July 25,2017. Please keep me posted about your case.Thanks.

Your inbox is full.

 

[anlindsey]

If you are in Canada, you can try www.justicenet.ca They provide legal services for a minimal fee depending on your income and number of dependents.