It’s possible for your Canadian permanent residence (PR) application to be refused due to medical inadmissibility. However, there are certain steps you can take to lower this risk and strengthen your case.

As of August 21, 2025, all new Express Entry applicants must provide an upfront Immigration Medical Exam (IME) when submitting their PR applications.

Before this change, medical exams were only requested after Immigration, Refugees and Citizenship Canada (IRCC) received the application.

Today, we will cover what you need to know when applying via Express Entry with medical issues.

So, without further ado, let us begin!

Excessive Demand On Health Or Social Services

For most Express Entry candidates, this is the most common medical inadmissibility issue. IRCC may decide that your health condition could place an excessive demand on Canada’s publicly funded services.

How IRCC Makes This Decision?

When evaluating whether your condition may cause excessive demand, IRCC looks at:

  • Your Immigration Medical Exam (IME) results
  • The current status of your health condition
  • The likely prognosis going forward
  • Whether treatment would increase wait times for others
  • Whether costs would exceed the set threshold for health or social services

For 2025, the cost threshold is $27,162 per year, or $135,810 over five years. IRCC revises this figure regularly.

Health Conditions Often Reviewed For Excessive Demand

Conditions that may trigger a review include:

  • Chronic illnesses (e.g., diabetes, kidney disease, cardiac issues)
  • Psychiatric conditions (bipolar disorder, schizophrenia)
  • Developmental disorders (Down syndrome, autism)
  • Mobility or neurological conditions (cerebral palsy, joint replacement)
  • Infectious diseases needing long-term treatment (hepatitis B/C, tuberculosis)

Even if your condition appears on this list, it does not mean automatic refusal. Each case is assessed individually.

What Can You Do To Reduce Risk?

If you think your health condition could be flagged for excessive demand, you can provide:

  • Proof of private health insurance to show reduced reliance on public care
  • Recent test results and medical opinions from your doctors, showing a good prognosis
  • Evidence of effective treatment, such as lab results proving your condition is stable

These documents can also be used in a mitigation plan, which we’ll cover later.

Risk To Public Health

Your PR application may be refused if IRCC believes your health condition could pose a public health risk in Canada.

How IRCC Assesses Public Health Risks?

Officers may review:

  • Results of your IME
  • Specialist reports, if requested
  • Whether you have been exposed to or currently have infectious diseases
  • How your condition could potentially affect others

Steps You Can Take

You can include documents in your application to show your condition does not pose a danger to public health, such as:

  • Recent specialist or general medical reports showing your condition is not contagious or is being treated
  • Lab results confirming treatment effectiveness
  • Proof of treatment or cure, along with follow-up test results

IRCC looks at each case individually. Having a past illness or exposure does not necessarily mean refusal.

Risk To Public Safety

Another thing to know when applying via Express Entry with medical issues is that your application can be refused if you are a risk to public safety.

What IRCC Considers?

Key factors include:

  • Risk of sudden incapacity (such as seizures or loss of consciousness)
  • Unpredictable or violent behaviour related to mental or neurological conditions

How To Show You Are Not A Safety Risk?

Applicants can strengthen their file by submitting:

  • Medical documentation showing the condition is under control
  • Specialist assessments confirming no risk to others
  • Evidence of treatment compliance, like prescriptions, therapy notes, or progress reports
  • Behavioral history reports, showing no violent incidents while managing the condition

IRCC will evaluate your case individually, focusing on stability and responsible management of your condition.

How To Overcome Medical Inadmissibility?

Before a refusal, IRCC usually issues a Procedural Fairness Letter (PFL) if they believe you may be medically inadmissible.

Responding to a Procedural Fairness Letter

The PFL usually contains:

  • A clear explanation of the officer’s concerns
  • A request for more documentation
  • A 90-day deadline to respond

When replying, you can provide:

  • Updated medical and specialist reports
  • Proof of treatment adjustments (new medications, therapies, etc.)
  • Evidence of cost-effective care, such as private funding or generic drug use
  • Documentation proving your condition is stable and manageable

If you need more time, you can request an extension to the 90-day deadline.

Submitting A Mitigation Plan

When the concern is excessive demand, IRCC may allow you to submit a mitigation plan. This plan shows how you’ll manage your health condition without over-relying on public resources.

What To Include In A Mitigation Plan?

A strong plan may contain:

  • Private health insurance to cover treatment or medications
  • Financial records proving you can pay for your care
  • Letters from your physicians outlining treatment plans
  • A history of your medical costs, showing consistency and affordability

Applicants must also include a Declaration of Ability and Willingness form, confirming they will take responsibility for their own care in Canada.

Note: You cannot opt out of Canada’s public healthcare system, but you can show that outpatient care (like prescriptions) will be privately covered.

Conclusion

Having a pre-existing medical condition does not automatically make you ineligible for permanent residence through Express Entry. What matters most is how well you demonstrate that your condition is managed, stable, and unlikely to strain public resources or endanger others.

By submitting clear documentation, responding effectively to any Procedural Fairness Letter, and preparing a mitigation plan if needed, you can significantly improve your chances of success.

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