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Medical Expense - surgical repair?

A client is indicating that she paid approx $10K to make medical repairs to breast Implant area. The implants were not the cause but scar tissue. The implants remained unchanged after the surgery.

I don’t really see a category that would allow the deduction.

Is there anybody with a similar issue? Any creative ideals of something that might work?

Thank you again.

G

I’d think it would be cosmetic surgury to fix scars. Cosmetic surgery after March 4, 2010 – an expense for cosmetic procedures incurred after March 4, 2010 will continue to qualify as a medical expense only if it is necessary for medical or reconstructive purposes, such as surgery to address a deformity related to a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease. Depending on how bad the scars are I’d think that would qualify as reconstructive surgery performed by a licensed surgeon and would be a qualified medical expense. I’d warn the client the CRA might not go for it but it’s probably allowable.

1 Like

@hetterly

In order for this surgery to be tax deductible, your client would need to obtain a letter from the surgeon or family doctor to substantiate the claim that this surgery was medically necessary for physical reasons.

A registered psychotherapist or psychiatrist could substantiate the claim that this surgery was medically necessary for emotional or mental health reasons.

For example a client’s obese daughter had attempted suicide a number of times due to school bullying due to weight. Her obesity was also affecting her health. Diets failed. Lap band surgery was recommended by the family doctor. Weight loss was deemed urgent for mental health reasons by the psychiatrist. Due to the extremely long wait times in Canada, this surgery was performed in Mexico. The medical claim was allowed based on emotional or mental health reasons.

Letter yes probably, but I wouldn’t put the contents that way.
Especially in this case clearly it IS (at a minimum) “for physical reasons”

To be more specific, to qualify for the Medical tax credit, the test (in this regard) is not that it be (some form of) “medically necessary”

Rather, the concern (to qualify for the credit) is rather to claim to see if the detailed medical documents support a claim under (say) pursuant to ITA S118.2(2)(a), but to NOT be caught by
ITA S118.2 (2.1) “The medical expenses referred to in subsection (2) do not include amounts paid for medical or dental services, nor any related expenses, provided purely for cosmetic purposes, unless necessary for medical or reconstructive purposes.”

I would copy/scan ALL supporting documents and save them in the file before making the claim, since a CRA “review” is almost guaranteed to follow later. (and also tell the client that).

@joe.justjoe1

Joe,
Although I did state “medically necessary”, the WHY medically necessary must be identified at the time of the tax claim and substantiated with details in the event of a medical review or audit.

Furthermore, each medical specialty or medical profession is limited to certain domains. That is what I was trying to clarify in my earlier post above.

For example, if the scaring is causing pain or is physically impairing functionality, then the letter should specify the reason(s) and expand on the supporting medical evidence such as professional opinion, test, examination, etc. In the event of an audit, the “medical reason” may be required to be further substantiated by history, specifics, and/or test results.

Etc.

I was trying to convey that is insufficient to simply state " medically necessary" for a medical letter to comply with CRA Review or Audit requirements.

It was scar tissue under the implant, not visible but was causing some major medical issues, the client had actually gone in thinking it was a heart attack.

“the WHY medically necessary must be identified at the time of the tax claim”

@dominique
Whilst perhaps a handy why of describing the general way it works to clients, I Don’t know where you are getting that phrase from exactly?

I don’t see anything about “medically necessary” per se.
(Specifically, ITA S118.2(2)(a) does not contain that phrase)

What they would be looking for (to not disallow upon Review) is some evidence that there is a medical reason other than “PURELY for cosmetic”…

The CRA current Cosmetic Review would like:
“Cosmetic procedures Send us a letter from the medical practitioner explaining the medical reason and nature of the cosmetic procedure or service, and date of the procedure or service.”

Thanks Joe. I did read the section. It is still not clear, the cosmetic part did not change and the doctor certainly felt it was necessary. The initial thought was the implant was leaking. Had it been leaking I would think it would be medically necessary. I’m tending to think it is in the “necessary for medical purposes”. If the implant was leaking I think it can be very difficult on the body (I’m not really sure but the old ones certainly caused a huge problem”.

I think the one thing against the claim is that it was not covered by health care. You would think if it was a crisis health care would step up to deal with it. I think some of the operations completed in Mexico that go badly are fixed under health care funds.

G

“Health Care” on the other hand, would likely only cover it if it was proven (to the Province or Plan Administrator) that it was “medically necessary” (or whatever) AND also on their (the Provinces/Administrators) list of approved codes for payment (or special authorization code), all depending on their policies – and the whim of the day of the person approving the special authorizing code…

“The initial thought was the implant was leaking.” - “Leaking” doesn’t sound “PURELY for cosmetic” to me…
and in any case, even if something was “PURELY for cosmetic”, sub (2.1) goes on to say “UNLESS necessary…”

That is to say, ITA S118.2 (2.1) may be a “leaking paragraph”… :wink:

@joe.justjoe1

My source and references.

  • school of hard knocks supporting client medical claim reviews and full audit.
  • one tax season at CRA with some training in the audit manual regarding medical claims, DTC, and caregiver amounts, and care homes.

Prior to one tax season in the CRA T1 call centre I had been trained through Liberty Tax, Video Tax News, and CPA firms. I used the “Preparing your income tax return” by Michael Mallin now sold through CCH Wolters Kluwer. During my training at CRA I was totally shocked at the disconnect between tax preparers’ and tax accountants’ perceptions and CRA’s administrative policies.

CRA applies administrative policies in conducting assessments, reviews, desk audit, and preparing for Tax Court. Depending up the program or focus of CRA’s review program more or less scrutiny is applied. Recently medical claims have come under frequent review.

Income Tax Folio S1-F1-C1, Medical Expense Tax Credit

Series 1: Individuals

Folio 1: Health and Medical

Chapter 1: Medical Expense Tax Credit

Persons seeking a less technical discussion of the medical expense tax credit are referred to Guide RC4065, Medical Expenses

https://www.canada.ca/en/revenue-agency/services/tax/technical-information/income-tax/income-tax-folios-index/series-1-individuals/folio-1-health-medical/income-tax-folio-s1-f1-c1-medical-expense-tax-credit.html#N110B8

Cosmetic procedures

1.143 An amount that may otherwise be an eligible medical expense described under subsection 118.2(2) may be denied pursuant to subsection 118.2(2.1) if the service was provided purely for cosmetic purposes. In particular, subsection 118.2(2.1) excludes from eligible medical expenses, an amount paid for medical or dental services (including any related expenses), which are provided purely for cosmetic purposes. Cosmetic procedures that are necessary for medical or reconstructive purposes will not be denied under subsection 118.2(2.1).

1.144 It is a question of fact whether a particular service or procedure was provided purely for cosmetic purposes, and the onus is on the individual claiming the credit to substantiate that a particular expense is not subject to this provision. Thus, where a particular medical procedure or service is cosmetic in nature, taxpayers may wish to obtain a detailed description of the nature and purpose of the medical service from the authorized medical practitioner performing the service as a means of establishing that subsection 118.2(2.1) does not apply.

1.145 Procedures that would generally be considered to have a medical or reconstructive purpose include those that would ameliorate a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease. Some common procedures, which are not disallowed by subsection 118.2(2.1) are:

  • breast implant and related procedures for reconstructive purposes after a mastectomy;
  • hair removal, in limited circumstances, such as for persons with polycystic ovarian syndrome; and
  • removal of excess skin after rapid weight loss due to a risk of infection.

1.146 Common procedures the costs of which are generally not considered to be eligible medical expenses because of the application of subsection 118.2(2.1) include:

  • augmentations (such as chin, cheek, lips);
  • filler injections (for removal of wrinkles);
  • liposuction; and
  • teeth whitening.

Receipts

1.147 Generally, all expenses claimed as eligible medical expenses must be supported by proper receipts. A receipt should indicate the purpose of the payment, the date of the payment, the patient for whom the payment was made and, if applicable, the audiologist, dentist, medical doctor, medical practitioner, nurse, occupational therapist, optometrist, pharmacist, physiotherapist, psychologist, or speech-language pathologist who prescribed the purchase or gave the service. A cancelled cheque is not acceptable as a substitute for a proper receipt. In addition to receipts, proof of payment or proof of support may be required in situations where an individual claims the medical expenses tax credit for amounts paid in respect of a dependant who is 18 years of age or older at the end of the year. If required forms, receipts or other supporting documents are not filed with the income tax return, such as when the return is electronically filed (E-filed), they should nevertheless be retained and readily available as they may subsequently be requested as proof of the claims being made or in support of the information being reported. Receipts are not required for meal and vehicle expenses claimed as transportation and travel expenses under paragraph 118.2(2)(g) and (h), or in connection with bone marrow or organ transplants under paragraph 118.2(2)(l.1) where the simplified method of calculating meal and vehicle expenses is chosen.

Not all medical practitioners are eligible in every province. They must be authorized by a professional or governing body.

Here is the table by province and territory. It does change over time.
https://www.canada.ca/en/revenue-agency/services/tax/individuals/topics/about-your-tax-return/tax-return/completing-a-tax-return/deductions-credits-expenses/lines-330-331-eligible-medical-expenses-you-claim-on-your-tax-return/authorized-medical-practitioners-purposes-medical-expense-tax-credit.html

“TO WHOM CAN ELIGIBLE MEDICAL FEES BE PAID”
https://www.canada.ca/en/revenue-agency/services/tax/technical-information/income-tax/income-tax-folios-index/series-1-individuals/folio-1-health-medical/income-tax-folio-s1-f1-c1-medical-expense-tax-credit.html#p1.24

Fees paid to medical professionals

1.24 Under paragraph 118.2(2)(a) an eligible medical expense includes an amount paid to a medical practitioner, dentist or nurse or a public or licensed private hospital for medical or dental services provided to the patient.

…ETC

“MEDICAL PROFESSIONAL”

https://www.canada.ca/en/revenue-agency/services/tax/technical-information/income-tax/income-tax-folios-index/series-1-individuals/folio-1-health-medical/income-tax-folio-s1-f1-c1-medical-expense-tax-credit.html#p1.20

References to medical professionals

1.20 This Chapter uses the terms medical doctor , medical practitioner , as well as various other terms to describe individuals involved in the medical profession, in a way that is consistent with the terms found in the Act. Medical practitioner encompasses a broad range of individuals in the medical profession.

1.21 For purposes of the medical expense tax credit as well as the disability tax credit (see Income Tax Folio S1-F1-C2 ) and the disability supports deduction (see Income Tax Folio S1-F1-C3 ), subsection 118.4(2) provides that a reference to an audiologist, dentist, medical doctor, medical practitioner, nurse, occupational therapist, optometrist, pharmacist, physiotherapist, psychologist, or speech-language pathologist is a reference to a person who is authorized to practice as such, according to the following laws:

a) for a service rendered to an individual, the laws of the jurisdiction in which the service is rendered;

b) for a certificate issued for an individual, the laws of the jurisdiction in which the individual resides or of a province; and

c) for a prescription issued to an individual for property to be provided to or for the use of the individual, the laws of the jurisdiction in which the individual resides, of a province or of the jurisdiction in which the prescription is filled.

1.22 In accordance with the decision of the Federal Court of Appeal in Canada v Couture, 2008 FCA 412, 2009 DTC 5040, it is the CRA’s view that an individual is authorized by the laws of the jurisdiction to act as a medical practitioner if there is specific legislation that enables, permits or empowers that individual to perform medical services. Generally, such specific legislation would provide for the licensing or certification of the practitioner as well as for the establishment of a governing body (for example, a college or board) with the authority to determine competency, enforce discipline and set basic standards of conduct.

1.23 Medical practitioners authorized to practice in accordance with the above laws can include the following (depending on the applicable province or jurisdiction, as the case may be): chiropractors, dental hygienists, dieticians, midwives, optometrists and naturopaths. A current list of Authorized medical practitioners by province or territory for the purposes of claiming medical expenses is available on the CRA website.