Got a medical procedural fairness letter: how to respond

By Pardeep S. Grewal, lawyer at Lawgical Law Corporation · Reviewed November 13, 2026

Published November 14, 2026

Pardeep S. Grewal is a lawyer at Lawgical Law Corporation, called to the BC bar in 2024, and a member of the Law Society of British Columbia.

Updated November 13, 2026: IRPA s. 38, IRPR s. 1(1) and IRCC’s 2026 excessive demand cost threshold checked that day.

A medical procedural fairness letter tells you that an IRCC officer believes you or a family member may be inadmissible on health grounds, usually for excessive demand on health or social services. It sets out the diagnosis, the services the officer expects you’ll need, and the estimated cost. You get one chance to answer before the officer decides, and the answer has to deal with the officer’s actual reasons.

Lawgical Law Corporation, an immigration law firm in Surrey, Abbotsford and Vancouver, BC, prepares responses to IRCC medical procedural fairness letters, including mitigation plans, and handles appeals and Federal Court reviews after a refusal; this guide is by Pardeep S. Grewal.

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What your letter says

Most letters follow the same pattern:

• The medical condition and the medical officer’s opinion;
• The health and social services you’re expected to need, and their estimated cost over five (sometimes ten) years;
• That the cost is above the excessive demand threshold ($144,390 over five years for 2026);
• Where social services are involved, an invitation to submit a mitigation plan and a Declaration of Ability and Intent;
• The deadline and where to send your response.

Three ways to answer

What makes a mitigation plan credible

Officers must consider your ability and intent to pay for social services (Hilewitz v. Canada (Minister of Citizenship and Immigration); De Jong v. Canada (Minister of Citizenship and Immigration), 2005 SCC 57). They look for a specific plan: which services, who provides them, what they cost, and how you’ll pay. A general promise to pay “whatever is needed” is rarely enough. Publicly funded hospital and physician care usually can’t be mitigated, so the plan should focus on the services that can be.

Evidence checklist

• The letter, the medical officer’s opinion and your full immigration medical file;
• Current reports from treating physicians that respond to the opinion;
• Medication lists with actual costs;
• Proof of income, assets and any private insurance;
• The signed declaration and a written plan for each service;
• Letters from family members who will help, with proof of their means.

If you’re refused anyway

Sponsored family members can appeal through the sponsor to the Immigration Appeal Division (IRPA s. 63(1)). Any refusal can be reviewed in the Federal Court (15 days inside Canada, 60 days outside). A temporary resident permit or humanitarian request may also help. See medical inadmissibility and excessive demand.

Why this needs a lawyer

One lawyer, one file, every step:

• reading the medical officer’s opinion and spotting what’s open to challenge;
• coordinating physician reports that answer the right questions;
• building the mitigation plan and declaration;
• the appeal or Federal Court review if needed.

The response is your only chance to change the officer’s mind before a decision. The legal test, not just the medical facts, decides what goes in it.

Immigration lawyers are members of a provincial law society (in our case, the Law Society of British Columbia), and only a lawyer can represent you in the Federal Court if a refusal has to be challenged there. An immigration consultant cannot appear in that court for you.

Common mistakes

• Sending a short doctor’s note that doesn’t respond to the officer’s opinion.
• A mitigation plan with no numbers.
• Trying to mitigate publicly funded hospital care.
• Letting the deadline pass while waiting for a medical appointment, instead of asking for an extension.
• Not keeping proof of what was sent and when.

Frequently asked questions

How long do I have to respond?

The deadline is in your letter, usually 90 days. Ask for more time in writing before it expires if you need it.

Is a procedural fairness letter a refusal?

No. It’s a warning that a refusal is likely unless your response changes the officer’s view.

Do I need a lawyer to respond?

You aren’t required to have one, but the response is often decisive, and only a lawyer can take a refusal to the Federal Court.

What if my child has a developmental condition?

Special education, social and vocational rehabilitation and personal support services no longer count as social services in the excessive demand test, which often lowers the estimate.

Related guides: medical inadmissibility and excessive demand, procedural fairness letters, IRCC medical furtherance letters.

What should I do right now?

Read the letter carefully, write down the deadline, request your medical file, and get advice before you gather evidence.

Book a consultation with our immigration lawyers in Surrey, Abbotsford or Vancouver, or online from anywhere.

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Sources (official)

• Immigration and Refugee Protection Act, s. 38(1)–(2)
• Immigration and Refugee Protection Regulations, s. 1(1) (definitions of excessive demand, health services and social services)
• IRCC program delivery update: 2026 excessive demand cost threshold (January 2, 2026)
• Hilewitz v. Canada (Minister of Citizenship and Immigration); De Jong v. Canada (Minister of Citizenship and Immigration), 2005 SCC 57
• Immigration and Refugee Protection Act, s. 63(1)
• Immigration and Refugee Protection Act, s. 72

This article is general information, not legal advice. Every case depends on its own facts.