From July 1, 2022, some NDIS terminologies have been updated.
Navigating the NDIS and understanding how the NDIS works can be a baffling and frustrating process. Understanding your rights as an NDIS participant or their representative/nominee can be half the battle won. Understanding what’s possible, provides more of a sense of control and reduces the feelings of powerlessness and uncertainty.
It is therefore important to be aware of your rights as a participant, potential participant or their nominee, when it comes to what decisions made by the NDIA can be appealed. The good news is that at this point in time, pretty much every decision made by the Agency or one of its representatives can be reviewed.
If at any point along the journey to becoming an NDIS participant and then as an actual participant, it is believed that an NDIA decision is wrong, you can request a review of the decision.
Which NDIA decisions can be reviewed?
There are two main types of reviews that can occur within the NDIS landscape:
- An internal review of an NDIA decision
- A review of an NDIS plan (now called plan reassessment) – and there are a couple of different reviews that can be requested at a number of different points over the course of a plan.
Being really clear about the type of review you are requesting is paramount in knowing which approach to take and how to go about it.
An internal review of an NDIA decision
Under the NDIS legislation, at Section 99, there are 25 identified reviewable decisions. Once a decision is made that relates to any of these, it is possible to seek a review of that decision. This type of review is called a ‘review of a reviewable decision’ or RoRD or S100 review, as it falls under Section 100 of the Act.
There are therefore many decisions made by the Agency that can be challenged and a very common one occurs at the time of an access request, when the request for access to the NDIS has been denied. This decision can be appealed.
The other most common decisions that can be challenged occur at the time of plan reassessments. This may be because a specific support, piece of equipment or modification that was requested has not been funded in the plan. Once again, there is the opportunity to collect and submit more evidence to the NDIA Delegate and to request a review of this funding decision.
If you are seeking a RoRD review, you must submit a request within three months of receiving the eligibility decision.
A review of an NDIS plan (now called plan reassessment)
There are three main types of plan reassessments that can occur in relation to a person’s NDIS plan.
- Full plan reassessments, which occurs towards the end of the current plan. This is standard practice and should occur prior to the expiry date of the plan.
- A plan reassessment can be requested when an NDIS plan does not meet the expectations of the participant. This must be requested by the participant or their nominee within three months of a plan being activated.
- A ‘change of circumstance’ (also called plan reassessment now) can be requested at any time during the life of a plan, if something has changed significantly for the participant.
How do I request a review of a decision?
Each time a decision is made by the Agency, you will be notified in writing. Along with the decision, you will be provided with information about how to request a review if you are not happy with a decision that has been made.
You can submit a written request to:
Chief Executive Officer
National Disability Insurance Agency
GPO Box 700
Canberra ACT 2601
You can also talk to someone at an NDIS office, call the 1800 800 110 hotline, send an email to: enquiries@ndis.gov.au.
In your communication, explain what decision you are seeking to have reviewed and provide information about why you believe the decision that has been made is not correct or reasonable.
You can also download and complete the Application for a review of a decision form from the NDIS website, but it’s not absolutely necessary.
What happens if I’m not happy about the outcome of a review?
If you are not happy with the outcome of an internal review, you can apply for an Administrative Appeals Tribunal (AAT) review. This is a tribunal that sits outside the NDIA and can review a range of decisions made by the NDIA, but only after an internal review undertaken by the Agency.
The list below includes some of the Agency decisions that can be taken to the Tribunal.
For example, the Agency may have decided:
- A person does not meet the access criteria
- Not to review a participant’s plan
- To make, or not to make, a determination about who may do things on behalf of a child
- To make, or not to make, a determination that a person has parental responsibility for a child
- To appoint a plan nominee or a correspondence nominee.
