Navigating the NDIS appeals maze

The National Disability Insurance Scheme (NDIS) and its delegates frequently emphasize that NDIS support coordinators should not act as participants’ advocates. However, for anyone who has occupied the role of a support coordinator—attending Administrative Appeals Tribunal (AAT) hearings, review meetings, and engaging in passionate discussions with delegates—the complexity of this position becomes evident. This is especially true in a system where advocacy resources are often stretched thin, leaving coordinators to navigate a delicate balance.

S100: Review of Reviewable Decisions (RORD) Process

To reach the Administrative Reviews Tribunal (ART)—the ultimate authority outside the NDIS—you first need to navigate the Review of Reviewable Decisions (RORD) process. Decisions from the RORD team can often be harsh, but you must receive a rejection letter from them to proceed to the ART. Think of it as challenging the “boss” before being allowed to reach the “ultimate boss.”
You have 100 days from the date of the decision to submit your RORD request. This request asks a delegate to review the previous decision and either amend it or confirm it without any changes. While you technically don’t need to provide new supporting evidence, doing so can significantly strengthen your case.

S34 of the NDIS Act and "Reasonable and Necessary" Supports

A decision made by the RORD team will be made in accordance with Section 34 of the NDIS Act. This section outlines what constitutes “reasonable and necessary” supports, which include:
  • Supports must be related to a participant’s disability.

  • Supports must not cover day-to-day living costs unrelated to disability needs (e.g., groceries).

  • Supports should represent value for money.

  • Supports must be likely to be effective and actually work for the participant.

  • Supports should take into account assistance from other government services, family, carers, and community networks.

The concept of value for money is a key focus for RORD delegates, and it can be difficult to argue against. Often, the NDIS favours cheaper, arguably underqualified options like support workers or allied health assistants over more qualified professionals, such as physiotherapists or occupational therapists, simply because their hourly rates are lower.

The Challenge of "Value for Money"

One of the most contentious aspects of the decision-making process is the focus on value for money. While the NDIS aims to ensure that the funds are spent efficiently, this sometimes results in participants being encouraged to rely on lower-cost supports that may not be adequately qualified to meet their needs. For instance, using support workers or allied health assistants, despite their lower cost, may not provide the level of expertise required to address specific support needs. This focus on cost-effectiveness often undermines the importance of the quality and efficacy of the support being provided.

Moving Forward to the Administrative Reviews Tribunal (ART)

If you are unable to get the outcome you want through the RORD process, the next step is to appeal to the Administrative Reviews Tribunal (ART). The ART is an independent body outside of the NDIS that has the authority to make binding decisions on appeals. It is often seen as the final avenue for participants to challenge NDIS decisions that they believe are unfair or do not adequately meet their needs.

The Road Ahead

The journey through the RORD process and potentially on to the ART can feel like navigating a labyrinth—time-consuming, exhausting, and often frustrating. Yet, persistence and understanding are key. Don’t be afraid. While the path may be difficult, knowledge of the process, your rights, and how to effectively present your case can make all the difference.
The NDIS review process may be intricate, but it exists as a measure to ensure that participants receive the supports they need. By staying informed and advocating for yourself or your loved one, you can better navigate the system and work towards securing the services that truly support your goals.
Remember, the maze may be complex, but with the right approach, you can find your way to a fairer and more effective outcome. In the end, knowledge is power, and with it, you can overcome the challenges and make the system work for you.

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