The Guidelines for the Discovery of Medical Inadmissibility at Stage 1

The officers would need to confirm medical inadmissibility first. Only then would the authorities be able to grant exemptions for overcoming these issues. For this, the officers would need to request the applicant to complete a medical examination at Stage 1. This is especially so if the authorities have assigned the case to an officer and if one of the following three conditions applies to the case:

• The applicant has specifically requested for an exemption from inadmissibility requirements concerning health (as specified in the provisions of A38) and the officer believes that various humanitarian and compassionate (H&C) factors could outweigh the inadmissibility
• The officer suspects that the case involves medical inadmissibility and finds compelling humanitarian and compassionate (H&C) considerations in the case
• The officer wants to refuse the case because of the medical inadmissibility

This is in accordance with the provisions specified in R30 (1) (d).

In some situations, the officers might find the confirmation of a medical inadmissibility and also, enough compelling circumstances that warrant the granting of an exemption. In this scenario, the officers would need to:

• Inform the applicant about the inadmissibility and provide an opportunity for the applicant to make the relevant submissions
• Consult with the provincial health authorities if needed
  • If they consult the authorities, they would need to include the results of any consultation as part of the referral package for the delegated decision maker and.
• Refer to the delegated decision maker

In case the officers find that the situation does not warrant an exemption, they would need to refuse the application. Officers have the ability to refuse the application without requesting for a medical if:

• They intend to refuse the application at Stage 1 and,
• The appearance of a possible medical inadmissibility would not lead to them changing their decision

Note:

• The authorities have enabled visa or immigration officers and Border Services Officers to issue medical instructions to visa / immigration officers
• Visa or immigration officers and Border Services Officers could instruct visa / immigration officers to provide the applicant with the Global Case Management System (GCMS) generated IMM 1017E and instructions
  • The client would then need to undergo the medical examination within 30 days of receiving the instructions
  • In some cases, the authorities might have permitted the client a dispensation for using a non-panelled physician
  • In this scenario, the visa or immigration officer would need to issue an IMM 5419E along with the IMM 1017E
  • In addition, the officers would need to add the comment ‘Permission given to use a non-panel physician’ at the top of the IMM 1017E
  • Thereafter, the officer would need to place a visa office stamp over the comment
• Similarly, visa or immigration officers and Border Services Officers could instruct Border Services Officers to provide the refugee claimant with the appropriate instructions
  • Thereafter, the Border Services Officers would need to remind the claimant to go for the medical examination within 30 days
• It is worth mentioning that clients also have the option of proceeding with an upfront medical examination before submitting their application
  • This is usually prescribed for certain categories as listed in the application guide
  • The Panel Physician would need to select the appropriate immigration category during the immigration medical examination
  • The Panel Physician has the ability to submit the medical files to Citizenship and Immigration Canada (CIC) on paper or electronically (eMedical)
  • Based on this, the applicant would receive a proof of completion of the upfront medical examination from the Panel Physician
  • Depending on whether the Panel Physician submitted the medical files on paper or electronically, the applicant would receive:
    • Either the first page of the IMM 1017B-Upfront (copy to client) or,
    • A printout from eMedical titled ‘Up-front Medical Notification’
  • The applicants would need to attach this proof of the upfront medical examination to their application, before submitting the application to the selected visa office
  • It is worth specifying that panel physicians will have the IMM 1017B – Upfront forms in their offices
    • In case panel physicians do not have these forms, they would need to contact their regional medical office for restocking

The Guidelines for the Discovery of Medical Inadmissibility at Stage 2

The officers would need to:

• Refuse the application for permanent residence if they determine that there are insufficient humanitarian and compassionate (H&C) grounds for granting an exemption to overcome the provisions specified in A38 and,
• Send the application to a delegated decision maker if the officers believe that various humanitarian and compassionate (H&C) factors might outweigh the health inadmissibility
• For more details, officers could refer to the section titled ‘The Process for Medical Refusals’ given earlier in this document

The Excessive Demand on Health or Social Services A38 (1) (c)

Officers would typically be assessing cases that involve the provisions specified in A38 (1) (c). These provisions refer to the Excessive Demand on Health and Social Services. While assessing these cases, the officers would need to consider the following factors:

• The cost of the treatment or care, if available
• The arrangements for covering treatment, care and other costs e.g. private insurance, family finances, public health coverage etc. (if the health inadmissibility is one that affects health or social services)
• Whether the applicant is likely to become self-supporting
• Whether the possibility of the person requiring public assistance exists and,
• The extent of the applicant’s anticipated need for health or social services in relation to the average demand for these services by Canadian residents

Quebec Cases

It is worth highlighting that the approval in principal i.e. a positive Stage 1 assessment would need to take place before the officers can request for a Certificat de Sélection du Québec (CSQ) from the Ministère de l’Immigration et des Communautés culturelles (MICC). This is why officers usually follow a different procedure for applicants residing in the province of Quebec.

• If the officers know about the applicant’s medical inadmissibility before the Stage 1 decision
  • The officers would need to send the application to the delegated decision maker if sufficient humanitarian and compassionate (H&C) considerations exist
  • In some situations, the decision of the decision maker might be positive
    • In this scenario, the officers would need to request for:
      • A Certificat de Sélection du Québec (CSQ) and,
      • A non-objection letter
    • The decision would continue to remain conditional until the authorities issue the Certificat de Sélection du Québec (CSQ) and the non-objection letter
  • Once the authorities issue the Certificat de Sélection du Québec (CSQ) and the letter of non-objection, the officers would need to finalise Stage 2
  • In case the authorities do not issue the Certificat de Sélection du Québec (CSQ), the officers would need to notify the applicant of the possibility of gaining admission to another province, if the situation warrants this
• In case the authorities discover the applicant’s medical inadmissibility after a positive Stage 1 decision
  • The officers would need to send the application to the delegated decision maker if sufficient humanitarian and compassionate (H&C) considerations exist
  • In some situations, the decision of the decision maker might be positive
    • In this scenario, the officers would need to request for a non-objection letter
    • They would do this even if the authorities have already issued a Certificat de Sélection du Québec (CSQ) without being aware of the applicant’s medical inadmissibility
    • The decision would continue to remain conditional until the authorities issue the non-objection letter
  • Once the authorities issue the Certificat de Sélection du Québec (CSQ) and the letter of non-objection, the officers would need to finalise Stage 2
  • In case the authorities do not issue the Certificat de Sélection du Québec (CSQ), the officers would need to notify the applicant of the possibility of gaining admission to another province, if the situation warrants this

Note:

• This specification applies to applications made in Canada and overseas