National Disability Insurance Scheme

The National Disability Insurance Scheme (NDIS) was introduced in 2013 to provide funding to support people who live with disability and children with early intervention needs. This page outlines the NDIS scheme and the processes for applying to be a participant in the scheme and for appealing against and seeking review of NDIS decisions.

Legislation

The NDIS is governed by the National Disability Insurance Scheme Act 2013. Appeals against and reviews of NDIS decisions are governed by the Administrative Appeals Tribunal Act 1975.

Why the National Disability Insurance Scheme?

The NDIS was introduced in response to a widespread concern that the existing disability support scheme was inadequate, outdated and poorly delivered. It was hoped that it would provide life-changing support for people with disability and their families.

Who is eligible?

A person is eligible to be an NDIS participant if they:

• are below the age of 65;
• are an Australian citizen or permanent resident who lives in Australia;
• have a disability that meets the criteria set out in section 24 of the Act or have early intervention requirements that meet the criteria set out in section 25 of the Act

Under section 24 of the Act, a person meets the disability requirements if they have a disability that:

• is attributable to an intellectual, cognitive, neurological, sensory, physical impairments or to one or more impairments attributable to a psychiatric condition; and
• is likely to be permanent; and
• results is substantially reduced capacity to undertake one or more of the following: communication, mobility, learning, social interaction, self-care and self-management; and
• the impairment affects their capacity for social and economic participation; and
• they are likely to need support under the NDIS for their lifetime.

Under section 25 of the Act, a person meets the early intervention requirements if:

• they have one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be, permanent; or
• they have one or more identified impairments that is attributable to a psychiatric condition and is likely to be permanent; or
• they are a child who has developmental delay;

AND the NDIA considers that early intervention support is likely to benefit the person and reduce their future needs in relation to their disability.

What can be claimed?

A person can apply to NDIS for funding for:

• daily personal activities
• transport to enable participation in community, social, economic and daily life activities
• assistance to allow a person to get or keep employment
• therapeutic supports including behaviour support
• help with household tasks
• skilled personnel in aids or equipment assessment, set up and training
• home modification design and construction
• mobility equipment
• vehicle modifications

Applying to be an NDIS participant

A person who believes they are eligible for NDIS can receive help to apply for the scheme.

They will be asked to provide information and evidence. The NDIA will use this information to make a decision and will inform the applicant of the decision within 21 days.

If the application is accepted, the information and evidence provided will be used to develop an NDIS plan. This is a plan based on the person’s goals and aspirations, their disability support needs and their personal circumstances and living situation.

There are four types of support that may be funded under an NDIS plan.

These are:

• core supports, to assist with everyday activities
• capacity-building supports, to help build independence and skills
• capital supports, for one-off purchases such as equipment and vehicle modification
• recurring supports

Internal review of NDIS decisions

A person who has received a decision of the National Disability Insurance Agency (NDIA) and believes that the decision is wrong can request internal review of the decision within three months of the date they receive the written decision. The NDIA will consider whether the decision was correct by looking at all the circumstances, including any new information or changed circumstances.

If a person is unhappy with the internal review decision they receive, they can seek an external review by the Administrative Appeals Tribunal (AAT) within 28 days of the internal review decision.

External review of NDIS decisions

When a person applies for external review by the AAT, the tribunal will consider the best way to deal with the application. It may proceed to a case conference, conciliation or a hearing. The tribunal may dismiss the matter if it is not a matter that can be reviewed.

A case conference involves the parties having an informal meeting to see if they can come to an agreement.

At a conciliation, parties are assisted by a conference registrar or member to come to an agreement.

At a hearing, a tribunal member will consider all the evidence that both parties have put forward. Parties will be allowed to call witnesses, but the rules of evidence do not apply, and the hearing will be conducted informally.

The tribunal member will then deliver a decision.

If you require legal advice or representation in any legal matter, please contact Armstrong Legal.