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NDIS Plan Reviews: I’m not satisfied with the NDIA’s decision so what is the process from here?

This FAQ explains the 3 types of reviews that you can request when you want the NDIA to reconsider a decision.

If you had a first NDIS first plan approved, or a plan review
done, or your application to access the scheme has been
denied and you believe that;

  • the plan is underfunded or
  • therapy reports/professional recommendations were not properly considered or;
  • your ability to provide informal supports is unsustainable

You can request that the NDIA reconsider this decision. This is called a
Review. There are 3 types of Reviews.

S100 Review

Within 3 months of that initial decision, you can request an Internal Review (done by a different delegate at NDIA). This is also called a Review of a Reviewable decision (RoRD) or a S100 review. You can make a request for an internal review of a decision by:

  • submitting a written request to:
    Chief Executive Officer
    National Disability Insurance Agency
    GPO Box 700
    Canberra
    ACT 2601
  • talking to someone at an NDIA office / by calling 1800 800 110 sending an email to: enquiries@ndis.gov.au.

When you ask for a review, you will need to explain why you think the decision is incorrect. Visit the Review your access decision page to download the application form. You don’t have to use this form, but it can help you describe why you want an internal review of the decision.
www.ndis.gov.au/participants/how-review-planning-decision

You will need evidence (usually new or updated ) to substantiate to the Internal Reviewer on:

  • how you meet the access requirements or
  • which reasonable & necessary supports you require and why.

This can include reports or letters of support from:

  • Medical specialists
  • Psychologists / Psychiatrists
  • Support Workers / service providers
  • Allied health therapists

A Functional Capacity Assessment from an OT is often a key document of evidence.

A piece of evidence often needed for this review is a Carer (Impact) Statement or Statement of Lived Experience. This is to show all the extra support you provide for your loved one that is beyond what you would provide for a neurotypical person living with you or supported by you. This link will explain what should go into this statement & how best to format it;

www.mycarespace.com.au/resources/writing-an-ndis-carer-statement-template

Your Support Coordinator, Service Coordinator, Support Provider Agency, LAC or an Advocate with experience in NDIS reviews can advise you on how to get all the documents & evidence together that you will need to support the review.

S48 review

If you have a change in circumstance which means your present plan/funding is no longer adequate for the new situation, you can apply anytime during the plan for a ‘change of circumstances review’ known internally as a S48 review or (CoC). This includes for example: changes to your disability needs, significant changes in your care or support provided by family or friends or changes to your living arrangements such as where you live. You will need evidence on what has changed and why a change of the plan will be necessary.

Your Support Coordinator, Service Coordinator, LAC or an Advocate specialising in NDIS reviews can advise you on how to get all the documents & evidence together that you will need to support the review. Where the NDIA agree to review the plan a review will occur.

It is important to know that if you are not happy with the outcome decision from a Change of Circumstances review you cannot take this decision straight to appeal to the AAT, but rather you will need to lodge another S100 review, then if you are not happy with THAT decision, you then take that to the AAT.

If the NDIA decide not to conduct a change of circumstance review, then that decision is automatically reviewed internally. The outcome of this internal review is known as an internal review decision. If the outcome of the internal review decision is still not to conduct a change of circumstance review, then this decision can be appealed to the AAT. However, the only decision before the AAT will be whether or not a change of circumstance review should occur; the AAT will not conduct the review of the funding itself.

AAT Review

AAT is the Administrative Appeals Tribunal (similar to a court setting). If you have already had an internal review of your/your family member’s current plan and are still unsatisfied with the result, then the next step for appeal is the AAT. This is an External Review, done by someone not at the NDIA.

It must be lodged within 28 days of the decision of the internal review. There is a way to apply for an extension of this 28 day period, the NDIA have to agree to extend this period. Information on this is found via this link;

www.aat.gov.au/apply-for-a-review/national-disability-insurance-scheme-ndis/time-limits

If you want legal support up to and attending the AAT hearing (and getting all the evidence together that you will need to support the claim) you may want to apply for funding through Legal Aid WA to assist you with this process. You can apply for Legal Aid once you have requested the AAT review. Here is a link to explain that process.

Applying for Legal Aid assistance:

www.legalaid.wa.gov.au/find-legal-answers/managing-your-
affairs/national-disability-insurance-scheme-ndis/disputes-ndis

Applications to request a review by the AAT can be made online here:

www.forms.aat.gov.au/landing.htm?formCode=app-for-review

For your information, here are the NDIS Guidelines on this;

www.ndis.gov.au/about-us/operational-guidelines/review-decisions-operational-guideline/review-decisions-operational-guideline-external-review-aat

The process starts with a case conference where an independent person from the tribunal reads everything you have submitted. The NDIA puts forward their reasoning for their decision. Then you work out if the NDIA will agree to fund it without a hearing, or if you will go to a hearing.

If you do take the matter to the AAT hearing, they will organise a conference call between the parties. You might want to seek an advocate to support you at the conference call/meeting. It is then either resolved or they may request for further evidence to substantiate your request. If you don’t have legal aid present, they may request that you do and AAT may organise for this to happen.

If the NDIA specifically request a particular piece of evidence for the AAT Review, the applicant can request that the NDIA provide assistance in obtaining that evidence (including financial assistance) under section 6 of the NDIS Act.

There are Advocates who may be able to assist in the reviews process. There may be a waitlist for this help.

  • People with Disabilities WA – 94207279*
  • MIDLAS – 9250 2123*
  • Explorability – 6361 6001*
  • Ethnic Disability Advocacy Centre – 9388 7455
  • Developmental Disability WA – 9420 7203
  • Individual Disability Advocacy Service (IDAS) – 6253 9500
  • Advocacy WA – 9721 6444
  • South West Autism Network – 0499 819 038

*funded to provided NDIS Advocacy services

Written by Leticia Grant, Advocacy Manager DDWA