🇨🇦 Applying through Express Entry with a pre-existing medical condition? This is what you have to know

Did you know your Canadian permanent residence (PR) application could be refused for medical reasons? Don’t worry too much—there are steps you can take to reduce the risk. 🙆‍♀️

👉 As of August 21, 2025, all new Express Entry applicants must submit an upfront Immigration Medical Exam (IME) with their PR application.

In the past, IRCC requested the exam after you submitted your application, but not anymore.

❌ Three Reasons IRCC May Find You Medically Inadmissible

1. Excessive Demand on Health or Social Services

This is the most common reason. IRCC may refuse your application if your health condition is

expected to create excessive costs or delays in Canada’s public system.

• IRCC looks at:

  • IME results

  • Current health condition & prognosis

  • Services required (and whether they affect wait times)

  • Whether costs exceed the threshold

💰 Excessive demand threshold (2025):

• $27,162 per year

• $135,810 over 5 years

Examples of conditions under review:

• Chronic diseases (diabetes, kidney, cardiac issues)

• Psychiatric conditions (bipolar, schizophrenia)

• Developmental conditions (autism, Down syndrome)

• Neurological/mobility issues (cerebral palsy, joint replacement)

• Infectious diseases (TB, hepatitis B/C)

👉 How to address this:

• Show proof of private health insurance

• Provide recent test results & doctors’ letters

• Submit documentation proving effective management of your condition

2. Danger to Public Health

Your application can be refused if your condition poses a risk to public health.

IRCC considers: IME, specialist reports, infectious disease exposure, and possible impact on others.

👉 How to address this:

• Submit up-to-date reports showing the condition is not contagious

• Provide treatment records and lab results

• If cured, show proof of treatment and negative test results

3. Danger to Public Safety

If IRCC believes your condition may compromise public safety, refusal is possible.

Examples:

• Risk of sudden incapacity (e.g., seizures, fainting)

• Violent or unpredictable behavior linked to neurological/mental conditions

👉 How to address this:

• Submit medical reports showing your condition is controlled

• Provide specialist assessments confirming no risk to others

• Show compliance with treatment (prescriptions, therapy, reports)

📩 Responding to a Procedural Fairness Letter

If IRCC is considering refusal, they’ll usually send you a Procedural Fairness Letter (PFL).

It includes:

• Officer’s concerns

• Request for documents

• 90-day deadline to respond

👉 In your response, include:

• Updated medical reports

• Proof of treatment (new medication, therapies)

• Cost-saving evidence (generic drugs, private insurance)

• Evidence of stability and effective management

⏳ You can request an extension if you need more time.

📝 Mitigation Plan (if invited)

For “excessive demand” cases, IRCC may invite you to submit a mitigation plan showing you can manage your condition without burdening public resources.

Include:

• Proof of private insurance

• Financial documents showing ability to cover costs

• Letters from doctors confirming care plans

• Personal history of covering medical expenses

Applicants must also sign the Declaration of Ability and Willingness, taking full responsibility for care in Canada.

(You can’t fully opt out of public health care, but you can show outpatient costs—like medications—will be privately funded.)

✅ Final Thoughts

Medical inadmissibility can feel like a major barrier to Canadian PR, but it’s not the end of the road. With:

• 📑 Proper documentation

• 🩺 Proof of treatment and stability

• 💰 Evidence of private funding

…many applicants are still able to overcome it.

👉 If you think you may be at risk, prepare early and consider getting professional advice to strengthen your case. Book a consultation now!

🇨🇦 Applying through Express Entry with a pre-existing medical condition? This is what you have to know