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Medical Inadmissibility Appeals and the Application of De Novo Evidence 

26-05-2015 medical_coverage

I am working on an Immigration Appeal Division (“IAD”) case involving the sponsorship of a family member who was found medically inadmissible. An interesting legal issue came up, which I found has not been widely discussed in immigration law texts, but may be very useful for practitioners and applicants alike: what happens if the Applicant’s condition or drug prices have changed since the initial negative decision and you are now at the IAD?

Facts

The loose factual situation is that since the negative medical inadmissibility report was issued several years ago, there have been several developments which (arguably) may not leave the individual medically inadmissible today. For example, as of June 2014, the minimum cost threshold (beyond which medical inadmissibility for excessive demand on health and social services would kick in) increased from $4,057 to $6,387 per month. This is a very substantial amount.

In our situation and in my estimate, the Applicant, according to today’s figures and our estimates of today’s prescription drug prices, may indeed fit under the new threshold and possibly the threshold from two years ago too.

Issue

Asides from the issue of challenging the reasonableness or correctness of the Visa Officer’s decision, can we introduce this new De Novo evidence as evidence of non-inadmissibility? In other words, can the IAD consider this evidence as a legal argument that the Applicant is no longer medically inadmissible?

Analysis provided by Vazirizadeh

The short answer appears to be no. The relevant case law authority for this is Vazirizadeh v. Canada (Minister of Citizenship and Immigration) 2009 FC 807. In Varzirizadeh, the Applicant had knee surgery following a medical inadmissibility finding based on osteoperosis. It was determined following the inadmissibility finding that one of her knees no longer required surgery. The IAD refused the Applicant’s appeal based on humanitarian and compassionate considerations, and the Applicant brought an Application for Leave and Judicial Review to the Federal Court now also challenging the legal validity of the decision.

The Applicant argued that as the IAD hearing was de novo, it should have considered the appellant’s changed medical status, whereas the Respondent Minister argued that the IAD considered both pre-surgery and post-surgery circumstances, and determined the medical inadmissibility had not changed (para 18). The Respondent also argued that de novo evidence could only reverse a medical inadmissibility finding if the evidence demonstrated that either the visa officer’s decision was incorrect at the time or breached the Applicant’s procedural fairness (at para 19).

Justice Frenette, citing the still oft-cited decision of the Federal Court of Appeal in Mohamed v. Canada (Minister of Employment and Immigration),  68 N.R. [1986] 3 FC 90, adopted the Respondent’s position concluding that “subsequent improvement in the medical condition was only relevant to whether special relief should be granted on appeal” (at para 20).

Therefore, it appears that arguments relating to change in medical condition or drug costs will not assist in challenging the legal validity of the Officer’s decision.

But, it is still useful in an appeal?

Application in a Recent IAD Case based on Special Relief – Boukrab

Boukrab v. Canada (Minister of Citizenship and Immigration) [2015] IADD No. 25 is an interesting case of a self-represented litigant who was found medically inadmissible by a visa officer as a result of rheumatoid polyarthritis (para 4).

The visa officer’s medical report itself [it was in French, so pardon my limited French translational abilities] found that the Applicant’s condition would likely continue to deteriorate and listed several drugs that he would require under Ontario’s medical insurance program.

In an effort to likely bolster the medical report, the Minister’s Delegate in hearing disclosure provided a Globe and Mail article which showed that injections or infusions for treating the condition would cost upwards of $20,000.

The Applicant’s arguments regarding the ability to “pay for his mother’s drugs,” were not accepted by the IAD which argued that as the government was statutorily obligated to pay, any undertaking to the contrary by the Applicant would be irrelevant.

However, the Applicant won the appeal on the basis of an updated letter from a rheumatologist dated August 29, 2014 indicating the condition was now stable and that the over-the-counter medication she took cost only $47.25 a month, an amount well below the threshold.

The Member upheld the medical inadmissibility finding but granted special relief (Humanitarian and Compassionate considerations). The Member was similarly impressed by the family’s attention to detail in establishing housing and transfer payments that were to be made.

Practical Tip: Estimating Drug Costs

Drug costs and equivalent treatment can sometimes be difficult to establish, particularly when the Applicant is located overseas and being treated by an overseas doctor. Many medications cost different amounts in different jurisdictions, sold under different labels and may have generic equivalents.

A good tip for Applicants or Counsel is to contact local support/non-profit groups relating to the condition that renders the Applicant inadmissible. These organizations, particularly local chapters, may have updated reports and studies which provide more accurate estimates of medical and social service costs.

It is important to recognize, particularly for negative decisions rendered abroad at foreign visa offices by foreign doctors/officers, is that the cost estimates are often done abroad and based on reports and surveys which possibly are less reliable (and possibly less individualized, local) than the ones you may have at your fingertips.

I also have this handy tool, provided to me by the kind folks at one of the organizations mentioned above, which may assist you in assessing the pre-subsidy prescription medication costs.

As stated on the website by the Pacific Blue Cross: “The Pharmacy Compass is an online tool developed by Pacific Blue Cross that may help you save money by comparing the average price for prescription drugs at different pharmacy locations across British Columbia based on claims submitted to Pacific Blue Cross over the past three months.” http://www.pharmacycompass.ca/FAQ

Once you have a cost estimated for the medication, it will be useful to do two steps. First, compare this amount to the cost threshold. In an ideal world, the cost is under $6,387 a month you may be in good shape. If the amount is slightly over, it may be worth investigating into the province’s subsidy scheme and determining the percentage paid by the government annually (reimbursed to the beneficiary). Here, your individual who is wealthy, but can’t use that wealth to demonstrate that they can pay for the costs out of their own pocket may be able to demonstrate that it affects the subsidized amount. Again, this analysis will have to be done on a province-specific basis and may not ultimately yield positive results. However, as summarized very well by one of my favourite Canadian immigration lawyers, Mario D. Bellissimo in  Chapter 11 – page 31 of Canadian Citizenship and Immigration Inadmissibility Law (2014) “The end result: excessive demands in one province may not be excessive demands in another province.”

Conclusion

Medical inadmissibility is a fascinating area of immigration law, one that is constantly changing based on changes to our health system and our knowledge of scientific treatments.

From what I have seen of it so far, it is often one of the most controversial. Medical inadmissibility cases often make it to the front page of the media, for the devastating affect it has in separating families.

I think it is an area where more case law will emerge, as applicants and counsel are better prepared to challenge the legal validity and put forth strong humanitarian and compassionate grounds for how they are not excessive burdens on the Canadian health system.

Let’s see what happens. Excited to see what happens to our case!

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The Best Law Advice I Ever Received: YDYIDM

Today’s Canadian legal market for up and coming lawyers ain’t a pretty one. There’s no need to put blush or makeup on the situation. As much as getting into law school was a task, finding a paying Canadian articling position in a major Canadian city is difficult. Getting hired back is more difficult, and being able to make a name for yourself as a junior lawyer another beast in its own right.

Recently, I’ve seen a lot of articles written by well-intentioned young lawyers and students purportedly offering go provide roadmaps on how to attain those positions/navigate the ropes . In fact, I was one of those well-intentioned students back in the day that provided advice left, right, and centre to anybody who would listen.

It is only now that looking back on things, I really didn’t know what I was talking about. I still don’t and I should probably stop trying to influence others with too many advice blog posts. The fact is, the journey into law, through law, and for many, eventually out of law is a personalized one. Just like it is impossible to fit a square peg into a round hole, you cannot box all law students and law firms into one. We all come at law with a different angle, with different hopes and dreams, and we will all eventually define our success differently.

My own journey is one where I wrote in my grade 7 year book that I wanted to be a lawyer. I didn’t even know what a lawyer was, but just heard (likely from my parents) that it is was an honourable profession. In my undergraduate days, thanks to some pro bono experiences and heavy community engagement projects, I thought I was going to be a human rights lawyer or an international arbitrator. In law school, having been caught up in the typhoid fever of 2nd year and the sexification of law through Suits, I thought I wanted to be a corporate M&A guy working on Bay Street.

Today, I stand to you as a humbled Articling student in Canadian immigration law, a soon to be associate, who struggles with the law on a daily basis. I grew up knowing no lawyers, won no awards in law school, was an average student at best, and today can say no more than I give it my best effort to help my clients with hardwork and creativity. However, I will strive to know the law better and represent them competently with the highest degree of ethics and compassion.

Funny enough, for all the countless stressing I did in law school and during my various legal interships, today I can finally say that the law does not stress me out. I enjoy it. I enjoy when it defeats me because I know that the beating I took today will save someone from a beating tomorrow. I am happy because I work in an area of law where it is all about the clients I work and I become an integral part of their most important days and decisions that’ll affect the rest of their lives.

Furthermore, I can use the law as a stepping stone to engage with the community and educate others. Law should not be a language spoken by the few to the many but should be utilized by the many with the few (us lawyers) ensuring that justice and the rule of law are not abused by institutions, governments, and vexatious litigants.

So my one advice to young students these days is always the same. You Do You, I Do Me = pursue your passion and commitment to something greater than yourself. Listen to everybody who has advice for you, but follow only the advice in your heart.

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Why CIC’s Tougher “Requirements” Might Actually Result in More Officer Discretion

Introduction

From a logical perspective, the more requirements there are for something you wish to obtain, for example job requirements or minimum scholarship requirements, the less room there is for any discretion.

Using a Canadian immigration example, part of the reason Labour Market Impact Assessments (“LMIA”) Applications are able to facilitate employment when the Employer clearly has a Foreign National candidate in mind is due to Employer’s ability to set the requirements for the job to meet the Foreign National’s unique profile. This allows them to prove to Service Canada that the decision to hire was not discretionary and therefore that the genuine efforts were made to hire Canadians.

However, contrary to the examples above, I believe there is a growing trend that will see requirements being used as a way to create discretion and will affect the consistency of Officer decision-making.

How Discretion Might Work

With both the new Express Entry application process and the Government’s proposed SIN-sharing regulations on both Permanent Residents (http://gazette.gc.ca/rp-pr/p1/2015/2015-02-28/html/reg2-eng.php) and Citizens (http://gazette.gc.ca/rp-pr/p1/2015/2015-02-28/html/reg1-eng.php), information will be requested from applicants that will exist beyond available memory and likely, even, available records.

In order to submit an Electronic Application for Permanent Residence under Express Entry, applicants are asked to provide a reference letter for every employment they have ever held, setting out terms of employment (duration, wage, benefits, etc.). Under the proposed SIN/data sharing legislation, Applicants are provided the “option” of providing SIN numbers. These SIN numbers will then be shared with CRA to access the Income Verification  Program. While not providing a SIN number cannot be a stand-alone reason for application refusal (according to the Regulatory Impact Analysis Statement), the groundwork is there for it being a reason to severely delay the application. [Editor’s note: Will be doing more indepth paper on this topic coming May 2015]

The ability of any human, let alone even tax/accounting software, to ensure all this information is accurate is in my opinion impossible. The requirements are high. I remember back in 2013 when I applied for Government of Canada Security Clearance (for an internship I never did), I only had to provide a 10-year work/employment history.

Now applicants will need to know the date of every trip ever taken, every dollar ever earned and possibly even spent. Past failures to keep accurate records of flights or the use of a less than capable tax accountant can now come back to bite an applicant in the behind.

Every application will contain errors. It is inevitable under this new “compliance heavy” regime. Yet, every application cannot be refused. Doing so would be a waste of everybody’s resources and make Canada an unattractive immigration destination. Needless to say, I believe immigration practitioners can no longer rely on the self-declarations/draft responses of an applicant when filling out forms and will ultimately need a piece of hard evidence (tax form, employment letter, or visa stamp) to verify each date and dollar provided.

Conclusion

I think that the new requirements give a discretion to immigration officers to refuse any application and to ensure that the application is not susceptible to appeal or review.

It will be interesting down the road, to compare reasons for refusal and uncover how said discretion is being applied. I wouldn’t be surprised if net worth and country and origin play a huge factor.

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My Value Proposition

My Canadian immigration/refugee legal practice is based on trust, honesty, hard-work, and communication. I don’t work for you. I work with you.

You know your story best, I help frame it and deal with the deeper workings of the system that you may not understand. I hope to educate you as we work together and empower you.

I aim for that moment in every matter, big or small, when a client tells me that I have become like family to them. This is why I do what I do.

I am a social justice advocate and a BIPOC. I stand with brothers and sisters in the LGBTQ2+ and Indigenous communities. I don’t discriminate based on the income-level of my clients – and open my doors to all. I understand the positions of relative privilege I come from and wish to never impose them on you. At the same time, I also come from vulnerability and can relate to your vulnerable experiences.

I am a fierce proponent of diversity and equality. I want to challenge the racist/prejudiced institutions that still underlie our Canadian democracy and still simmer in deep-ceded mistrusts between cultural communities. I want to shatter those barriers for the next generation – our kids.

I come from humble roots, the product of immigrant parents with an immigrant spouse. I know that my birth in this country does not entitle me to anything here. I am a settler on First Nations land. Reconciliation is not something we can stick on our chests but something we need to open our hearts to. It involves acknowledging wrongdoing for the past but an optimistic hope for the future.

I love my job! I get to help people for a living through some of their most difficult and life-altering times. I am grateful for my work and for my every client.

Awards & Recognition

Canadian Bar Association Founders' Award 2020

Best Canadian Law Blog and Commentary 2019

Best New Canadian Law Blog 2015

Best Lawyers Listed 2019-2021