By Amir Ansari, RCIC, Ansari Immigration, Vancouver
An excessive demand fairness letter is not a refusal. It means a medical officer believes your health condition, or a family member's, might cost Canada more than the excessive demand cost threshold, and IRCC is giving you a set window, usually 90 days, to respond before any decision is made. What you send back can change the outcome.
Why this stage matters more than any other
Most people who open this letter read the word "inadmissible" and assume the application is over. It is not. This is the one stage of a medical refusal where the decision has not yet been made and your evidence still counts. A procedural fairness letter is a warning shot with a deadline attached, and the file is decided on what you put in front of the officer before that deadline passes. Below is what the letter actually means, who it does not even apply to, and how to use the time you are given, drawn from IRCC's published guidance and from IRCC's own letter templates released under the Access to Information Act.
What an excessive demand fairness letter actually is
Canada assesses three kinds of medical inadmissibility. This letter is about the third one only.
Ground of medical inadmissibility |
What it covers |
Is this letter about it? |
Danger to public health |
Decided on your immigration medical exam results, including third-party laboratory tests |
No |
Danger to public safety |
Risk of sudden incapacity or unpredictable behaviour |
No |
Excessive demand on health or social services |
Services that would add to wait times in Canada, or would likely cost more than the cost threshold |
Yes |
Source: IRCC, Medical inadmissibility. Verified October 2026.
The threshold is a published number, not an officer's guess. For 2026 it is $144,390 over 5 years, or $28,878 per year, and IRCC updates it most years. A condition triggers excessive demand if the services it needs would either add to wait times for Canadians, or would likely cost more than that figure.
The two kinds of service behind the number are treated very differently when you respond. Health services are the ones mostly paid by government: physicians, hospitals, prescription drugs dispensed in hospital. Social services are things like home care, special education and vocational support. Keep that distinction in mind, because it decides which of the two response strategies below is open to you.
A fairness letter is IRCC telling you, before any final decision, exactly why it believes you may be inadmissible and inviting you to reply. IRCC's published guidance is explicit that the letter comes before a final decision and that you may send information in response. The officer has a concern, not a conclusion.
First, check whether the rule even applies to you
Before you spend a dollar on evidence, confirm you are not in an exempt category. IRCC states that the medical inadmissibility rules for excessive demand reasons do not apply to:
refugees and their dependants
protected persons
certain people being sponsored by their family, such as dependant children, spouses and common-law partners
Source: IRCC, Medical inadmissibility. Verified October 2026.
If you are being sponsored as a spouse, common-law partner or dependent child under family sponsorship, excessive demand is not a ground that can refuse you. Only danger to public health or public safety could. If the letter still arrived, say so in your response, and get a second look before you build an expensive evidence package you may not need. The same goes for anyone whose medical was already handled as an exemption case: our guide to the upfront medical exam covers who is out of scope and when an older medical still counts.
Where your file goes, and the clock you are actually on
Here is detail that is hard to find on any public page, because it comes from IRCC's internal letter templates, released as request A-2025-81953 and dated December 2025: the excessive demand letters tell the applicant their file has been transferred to IRCC's medical office in Niagara Falls, Ontario, which handles complex medical considerations. So if your file suddenly shows a Niagara Falls office, that is why. It is a routing step, not a bad sign in itself.
On timing there is a nuance worth understanding, because three different numbers circulate and they are not interchangeable.
Which letter you are holding |
Window to respond |
Where that number comes from |
A first excessive demand fairness letter |
90 days from the date on the letter, with an extension available if you ask |
IRCC's published guidance |
A second "public policy" letter, sent to someone already given a first chance |
A shorter 60-day window, and a direction not to resend documents already sent |
IRCC's internal letter templates, A-2025-81953, December 2025 |
An officer setting a window at all |
A floor of a minimum of 60 days |
IRCC's older operational manual for officers |
Source: IRCC, Medical inadmissibility for the 90-day rule. Verified October 2026. The 60-day figures come from internal and older operational documents, not from current public guidance, so treat them as context for what you are holding rather than as the rule that governs your file.
The practical takeaway: go by the exact date printed in your letter, not by a number you read online. If it says 90 days, you have 90. If it is a second letter, you may have less. And if you need more time, ask before the deadline, not after. IRCC's published guidance says that if you cannot respond by that date, you must contact IRCC to request an extension using the contact information in the letter.
Here is how that plays out in practice. The following is an illustrative scenario built only from the verified rules above, not a particular client file.
An Express Entry applicant's 9-year-old daughter has a condition requiring special education, which is a social service. Because an inadmissible family member can, under section 42 of the Immigration and Refugee Protection Act, make the applicant inadmissible too, the principal applicant, who is perfectly healthy, receives the excessive demand letter on account of his daughter's condition. The family is not refused. They respond inside the 90 days with a realistic plan showing how they will cover the special-education costs privately, plus the sworn declaration IRCC provides. The medical officer re-reviews. That is the system working as intended, and it is the ordinary outcome when the response is built properly and filed on time.
Does a 90-day clock feel like enough time to assemble medical and cost evidence across two countries? Tell us below what you found hardest.
If you are holding one of these letters and you are not sure whether you are exempt or what a realistic response looks like, that is a 30-minute conversation, and the RCIC who would handle your file is the person who answers.
Ask about your fairness letter
How you actually respond
IRCC's officer guidance is that for a possible excessive demand case the officer sends the model letter and gives the applicant a declaration template. IRCC's manual calls it a Declaration of Ability and Intent; the December 2025 templates title it a Declaration of Ability and Willingness. You respond on one of two tracks, depending on what is driving the cost:
Social services, meaning special education, home care or vocational support: you can submit a mitigation plan and the sworn declaration, a credible and specific plan showing you can and will cover those costs without relying on publicly funded services, with evidence of the means to do it. This is where applicants have real leverage.
Health services, meaning hospital care and physician services, and the wait-times limb: these are much harder to mitigate privately, because you cannot buy your way out of a public wait list. Here the stronger move is usually medical evidence that challenges the officer's cost or prognosis estimate itself.
IRCC publishes its own instructions on how to prepare a mitigation plan for excessive demand, and it notes that you will be invited to send one only if it applies to your situation.
On mechanics, IRCC's templates are specific. Before you send anything, check all of these:
Respond through the channel the letter names, not a general IRCC inbox
Keep attachments within the stated size limit
Use the exact subject line the letter gives you
Do not send original documents unless they are specifically requested, because submitted documents are not returned
If this is a second letter, do not resend documents you already provided
If you need more time, request the extension before the deadline passes
After you respond, the officer forwards your material to the medical officer, who either confirms the original opinion or withdraws it and reopens the assessment. If you send nothing within the time allowed, the officer decides on the file as it stands, which means a refusal. The medical assessment behind all of this starts with your immigration medical exam, and the cost and prognosis figures in the letter trace back to it.
Do you need a representative for this?
You are probably already asking. IRCC's own guidance says you may get advice or representation but that it is not required, and that is worth taking at face value. A straightforward case, meaning a clear exemption or a single social-service cost with obvious private means to cover it, is something many people can answer themselves.
Where a licensed representative earns the fee is in the harder cases: building a mitigation plan and declaration that an officer will actually accept, assembling cost and prognosis evidence that rebuts the medical officer's estimate, and spotting when the letter should not have been sent at all. The deadline is fixed and the file is decided on what you submit, so a weak or late response is the expensive mistake, not the fee. If this letter arrived on a permanent residence application you have already spent a year on, that asymmetry is the whole argument.
Frequently asked questions about the excessive demand fairness letter
Is an excessive demand fairness letter the same as a refusal?
An excessive demand fairness letter is not a refusal: it is IRCC telling you its concern before any decision is made and giving you a set period, usually 90 days, to respond. After you reply, the medical officer either confirms the original opinion or withdraws it and reopens the assessment. The refusal only comes if you send nothing, or if your response does not answer the concern.
How long do I have to respond to an IRCC medical fairness letter?
IRCC's published guidance gives you 90 days from the date on the letter to send additional information, and tells you to contact IRCC for an extension if you cannot meet that date. A second "public policy" letter, sent to someone who was already given a first chance, can run on a shorter 60-day window instead. Follow the exact date printed in your own letter, and ask for more time before it passes rather than after.
Does excessive demand apply to spouses and children being sponsored?
The excessive demand rules do not apply to refugees and their dependants, protected persons, or certain people being sponsored by their family such as dependant children, spouses and common-law partners. If you are in one of those categories, excessive demand cannot be the ground of refusal, and only danger to public health or public safety could be. If a letter reached you anyway, raise the exemption directly in your response.
What is the 2026 excessive demand cost threshold?
For 2026 the excessive demand cost threshold is $144,390 over five years, which works out to $28,878 per year. IRCC uses it to decide whether the likely cost of the health or social services your condition needs counts as excessive, and it updates the figure most years. A condition can also trigger excessive demand without reaching that cost, if the services involved would add to wait times for people already in Canada.
Why work with Ansari Immigration
A fairness letter is a deadline, and the response is either built properly the first time or it is not. Ansari Immigration quotes flat, transparent fees upfront for this work, and every file is handled personally by the firm's licensed RCIC (R709304), regulated by CICC, with a reply within one business day. No juniors, no call centres.
Book a consultation about your fairness letter
at $80 for 30 minutes.
Have you received one of these letters, or helped someone through one? Tell us in the comments what the hardest part was. Keep it general, and for advice on your own file use a consultation.
Related Posts
Medical Inadmissibility Canada: Excessive Demand Explained (2026): The full picture of how excessive demand is assessed and the grounds behind this letter.
What Is a Procedural Fairness Letter from IRCC (PFL)?: How fairness letters work across all application types, not just medical ones.
Panel Physician Canada: How the Immigration Medical Exam Works and When to Book: Where the medical assessment behind the letter begins.
This article is for general information only. It is not legal advice. Program criteria, requirements, processing times, and selection approaches can change without notice. Always confirm details on official government websites or consult a licensed Regulated Canadian Immigration Consultant (RCIC) for advice specific to your situation.