DOCUMENT 3
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For Internal Use Only
National Disability Insurance Agency
Reviews and Information Release Division
Standard Operating Procedure: Reviewing the Matter
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Document Control
| Field | Details |
|---|---|
| Document No. | NDIA-ERB-SOP-028 |
| Date | October 2025 |
| Status | FINAL |
| Version | 1.1 |
| Document applicability | National — Reviews and Information Release Division |
| Owner | Director, Performance, Policy, and Quality |
Approval Status Log
| Field | Details |
|---|---|
| Version | 001 |
| Reviewed by | Policy Officer |
| Endorsed by | |
| Approved by | Assistant Director, Policy |
| Approval date | 30 October 2025 |
Revision History
| Revision | Date | Sections | Summary of Changes |
|---|---|---|---|
| Original 1 |
19/03/2025 | All | Original (formerly NDIA-ART CM-SOP-028) Amended to align with NDIA organisational restructure |
| 1.1 | 30/10/2025 | All | Amended to align with NDIA organisational restructure |
Note: Document uncontrolled in hardcopy
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Contents
- Introduction …………………………………………………………………………………….. 3 1.1 Purpose …………………………………………………………………………………….. 3 1.2 Scope ……………………………………………………………………………………… 3 1.3 Roles and Responsibilities …………………………………………………………………. 3
- Checklist ……………………………………………………………………………………….. 4
- Procedure ……………………………………………………………………………………… 4 3.1 Review application in LEX …………………………………………………………………. 4 3.1.1 Preliminary considerations ……………………………………………………….. 4 3.1.2 Review information recorded by Early Assessment ……………………………… 4 3.1.3 Other considerations ………………………………………………………………. 5 3.2 Consider evidence and issues in dispute ………………………………………………… 5 3.2.1 Current evidence …………………………………………………………………….. 5 3.2.2 Supports currently funded and a review of PACE and CRM ……………………… 5 3.2.3 If further evidence is required ……………………………………………………. 6 3.2.4 Initial contact with the participant or prospective participant ……………….. 6 3.2.5 Internal Specialist Teams ………………………………………………………….. 7 3.3 Consider pathways for resolution ……………………………………………………….. 7 3.4 Clear Statement of Issues (SOI) …………………………………………………………. 8 3.5 Summary …………………………………………………………………………………….. 9 3.6 Process Flowchart ………………………………………………………………………….. 10
- Annexures …………………………………………………………………………………….. 11 4.1 Annexure A – Introductory email to Lawyer ……………………………………………. 11 4.2 Annexure B – Introductory email to a self-represented Participant or Prospective Participant ………………………………………………………………………… 13
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1. Introduction
1.1 Purpose
This Standard Operating Procedure provides step-by-step guidance to Case Managers on reviewing newly allocated matters. This procedure also provides information and guidance around the draft and clearance of the Agency’s Statement of Issues (SOI) for filing in the Administrative Review Tribunal (ART).
1.2 Scope
This procedure applies nationally across the External Review Branch (ERB), and is to be used by:
- Case Managers.
1.3 Roles and Responsibilities
The roles and responsibilities set out in the Standard Operating Procedure: Document Control apply also to this procedure.
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2. Checklist
| Topic | Checklist |
|---|---|
| Pre-Requisites | 🧰 A matter has been allocated to you in LEX |
| Actions | 🧰 3.1 Review application in LEX |
| 🧰 3.2 Consider evidence and | |
| 🧰 3.3 Consider pathways for resolution | |
| 🧰 3.4 Clear Statement of Issues (SOI) | |
| 🧰 3.5 Summary | |
| 🧰 3.6 Process Flowchart |
3. Procedure
3.1 Review application in LEX
3.1.1 Preliminary considerations
You will receive an automatically generated email once a matter has been allocated to you in LEX.
Once you receive an email confirming that a matter has been allocated to you:
- Ensure that you assign all relevant reminders to yourself in LEX;
- Review the Documents and Reminders tabs in LEX to identify any upcoming listings;
- Add upcoming listings or meetings to your Outlook calendar — including, but not limited to, Case Conferences and Directions Hearings;
- Update the existing alert in PACE and CRM, to include your email as the point of contact. For example, the alert should read ‘ART Application Active — Prior to commencing any review process, please contact
’; and - Review any LEX Alerts around accessibility and/or sensitive themes.
3.1.2 Review information recorded by Early Assessment
When reviewing a newly allocated matter, you will also review any file notes regarding Early Assessment (if applicable) to determine the following:
- What are the identified issues in dispute?
- Was an offer made, and the outcome of that offer?
- Consider any legal or internal specialist advice obtained to date.
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DR Case Managers must also send copies of any further evidence which was provided to the EA Case Manager, to the Lawyer with carriage (once assigned). This is to ensure that all parties engaged in the matter have access to all of the available information.
DR Case Managers should contact the EA Case Manager if they have any queries or would like to discuss the progression of the matter.
3.1.3 Other considerations
If and when a Lawyer has been assigned, you should email the Lawyer with carriage of the matter. If a Lawyer has not been assigned to the matter, you should email ART.correspondence@ndis.gov.au instead, requesting that a Lawyer be assigned to the matter. A template for your introductory email to the Lawyer, once assigned, can be found at
Annexure A – Introductory email to Lawyer.
What to do if there is a possible jurisdictional error
If you identify a potential jurisdictional issue, raise it with your Line Manager in the first instance and bring it to the attention of the Lawyer with carriage of the matter for inclusion in the Agency’s Statement of Issues (SOI).
3.2 Consider evidence and issues in dispute
The Case Manager is responsible for reviewing the evidence provided by the participant or prospective participant to date, and for determining whether any additional evidence is required in order to progress the matter towards resolution, if possible, or to prepare for the first Case Conference.
In particular, the Case Manager should consider:
3.2.1 Current evidence
The issues in dispute are to be reviewed in line with the current evidence, against the relevant guidelines and legislation – in particular, sections 10, 24, 25, 33, 34, 44 and 46 of the National Disability Insurance Scheme Act 2013, the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Bill 2024, the National Disability Insurance Scheme (Becoming a Participant) Rules 2016, the National Disability Insurance Scheme (Supports for Participants) Rules 2013, NDIA Operational Guidelines and Standard Operating Procedures, and previous AAT and ART decisions which may be relevant to the matter.
3.2.2 Supports currently funded and a review of PACE and CRM
When dealing with planning matters, it is also important to consider the type, level and amount of funding available to the participant in their current plan. This is done by reviewing their plan breakdown in PACE or CRM (if applicable).
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For guidance on how to locate information related the breakdown of a participant’s plan in PACE, refer to the Knowledge Article: Review the budget.
For guidance on how to locate information related to the breakdown of a participant’s plan in CRM, please refer to the NDIA Standard Operating Procedure: Monitoring the plan budget.
3.2.3 If further evidence is required
If further evidence is required, you will need to consider, together with the Lawyer with carriage of the matter, the following:
- What further evidence is required to reach resolution, if possible?
- What further evidence would help the ART in making its decision?
- Who should give further evidence? This can be Allied Health Practitioners and/or internal specialist teams, among others.
- Is the participant or prospective participant able to provide further evidence? This can be in the form of a Statement of Lived Experience, a timetable of supports, updated quotes, etc.
3.2.4 Initial contact with the participant or prospective participant
To ensure that the participant or prospective participant is aware of the Case Manager with carriage, the Case Manager will contact the participant or prospective participant (or their representative) within 5 days of the matter being allocated to them. It is the Case Manager’s responsibility to contact the participant or prospective participant, except in the scenarios below.
Contact should be made using the recipient’s preferred method of communication, followed by an email containing the Case Manager’s contact details. A template for that email is contained at Annexure B – Introductory email to redacted.
Case Managers should refer to the ART Application, the Authorised Reps tab in PACE (under the Relationships tab of the participant’s or prospective participant’s record) and the Contacts tab in CRM (if applicable) to confirm whether the participant or prospective participant has a representative, plan nominee, or child representative.
If the participant or prospective participant is legally represented
If the participant or prospective participant has legal representation, DR&L or the Lawyer acting in the matter will contact the participant’s or prospective participant’s legal representative.
If the participant or prospective participant has a plan nominee
If a participant or prospective participant has a plan nominee, and their plan nominee lodged the ART Application on their behalf, contact should be made
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with the plan nominee, instead of with the participant or prospective participant, in the first instance.
If the participant or prospective participant is a minor or has a guardian
In matters involving participants or prospective participants who are minors, or who are subject to Guardianship Orders, contact will be made with the participant’s or prospective participant’s child representative or guardian, using their preferred method of contact.
3.2.5 Internal Specialist Teams
Technical Advice and Practice Improvement Branch (TAPIB)
As part of the management of matters before the ART it will often be necessary to seek clinical and/or internal subject matter advice from TAPIB. Further information is available on the TAPIB intranet page and the TAPIB Hub.
All supports that require mandatory TAPIB advice are listed in the related Practice Guides, and on the following intranet pages:
- Assistive Technology
- Home Modifications
- Vehicle Modifications
- Disability Related Health Supports
- Core, Capacity Building and Mainstream Interface Supports
TAPIB advice must also be requested in relation to a request for access to the Scheme for a chronic health condition or for prospective participants with terminal or potentially terminal health conditions.
Additionally, TAPIB advice is mandatory to inform a decision regarding whether a matter will proceed to hearing.
TAPIB advice is also required in order to engage an Independent Medical Expert (IME), subject to EL1 or EL2 approval.
TAPIB advice request forms can be accessed from the External Review Branch Guidance Library and Directory.
Please note: All requests for TAPIB advice need endorsement from an EL1.
3.3 Consider pathways for resolution
If, on the basis of all the available evidence, a requested support does not meet the reasonable and necessary criteria or a request does not meet the eligibility criteria for access to the Scheme, Case Managers must consider what other support or information can be made available to the participant or prospective participant through mainstream systems of support delivery to help them meet their goals, and resolve the matter before the ART.
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When considering which resolution pathway would be most appropriate, to help guide your understanding of the issue(s) in dispute, you will review all prior interactions with the participant or prospective participant, and any offers previously made to resolve the matter. This includes reviewing the outcome of, and any relevant file notes created during, the Early Assessment process.
You must ensure that any proposed resolution is relevant to the decision under review. For example, if the decision of the NDIA was not to conduct a plan review, the only decision before the ART is whether or not to conduct a plan review.
When developing possible resolution options, consideration should be given to any perceived risks.
For further procedural guidance regarding potential resolution pathways, please refer to the following resources:
- Standard Operating Procedure: Resolved by Consent, which includes guidance on how to formulate and present an offer to a participant or prospective participant
- Standard Operating Procedure: Dispute Resolution
- Standard Operating Procedure: Resolved by Hearing
- Standard Operating Procedure: Withdrawal, Dismissal and Reinstatement
- Decision-Making Authority for Case Managers
3.4 Clear Statement of Issues (SOI)
If a matter is unable to be resolved in full prior to the first Case Conference, the matter will proceed as listed. Please see the Standard Operating Procedure: Dispute Resolution for guidance relating to Case Conferences.
The Agency is required to file a SOI ahead of the Case Conference. A template SOI is annexed to the Agency’s Standing Instructions, a copy of which is located in the Dispute Resolution and Litigation Branch Guidance Library and Directory.
As part of your introductory email to the Lawyer at 3.1.3 above, the CM will instruct the Lawyer to draft the Agency’s SOI for your review and clearance.
Once drafted, the CM will clear the SOI for filing based on your review of the matter and the full breadth of available evidence.
Once reviewed and cleared by the CM, the Lawyer will file a copy of the SOI with the ART, and provide filed copies to you and the participant or prospective participant (or their representative).
As outlined within the Agency’s Standing Instructions, the timing for preparing/filing SOIs is as follows:
- no later than five working days before a Case Conference, the draft SOI is to be provided to the Case Manager; and
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- the Lawyer must file the SOI, two clear working days before the Case Conference, or otherwise in accordance with any Tribunal direction.
3.5 Summary
In summary, the key responsibilities of a Case Manager are:
- To provide instructions to internal and/or external Lawyers
- To assess and review evidence and issues in dispute.
- To clear all documents lodged with the ART (such as the SOI).
- To deliver results through the effective case management of applications before the ART in relation to NDIA plan and NDIA access decisions.
- To provide timely and reliable responses to participants or prospective participants, in order to ensure:
- the effective management of ART applications received by the NDIA;
- the early resolution of ART matters, where possible;
- the relevant evidence and information are obtained in order to reach the best possible outcomes for participants or prospective participants; and
- there is accurate and appropriate record keeping in LEX and CRM/PACE.
- To attend Tribunal case events (including Case Conferences, Conciliations and Hearings).
- The Case Manager is responsible for completing the ALOC Paper with the assistance of the Internal Legal Officer and any external Legal Service Providers (LSPs) engaged in the matter.
- To assess and respond to risks arising from ART applications, including risks to the financial sustainability and priority of the Scheme.
- To act appropriately in response to legal and technical advice.
- To assist the Director and Assistant Director to prepare reports, meeting submissions and correspondence.
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3.6 Process Flowchart
[Flowchart diagram depicting the review process from ‘Matter allocated to CM in LEX’ through 3.1, 3.2, 3.3, 3.4, and subsequent paths to ‘Process End’]
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4. Annexures
4.1 Annexure A — Introductory email to Lawyer
TO: Lawyer
Subject: Statement of Issues and Case Manager Introduction — [Participant or Prospective Participant Name] and NDIA — [ART Proceeding No.] - LEXD [LEX No]
Good [morning/afternoon] [Lawyer name],
I am the Case Manager assigned to this matter.
Could you please prepare a Statement of Issues (SOI) [if required: and Litigation Strategy], ahead of the Case Conference which is scheduled for [date].
When drafting the SOI, please consider the following in particular:
[delete if not applicable] Please see attached relevant documents which are not included in the Agency’s T-Documents filed in this matter:
[Delete if not applicable] Please see a breakdown of the participant’s current plan below, to assist you in preparing the SOI:
Current Approved Support Details — NDIS Plan
| Budget Category | Line-Items | Value |
|---|---|---|
| CORE | $ | |
| Consumables | $ | |
| Daily Activities | $ |
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Current Approved Support Details — NDIS Plan
| Budget Category | Line-Items | Value |
|---|---|---|
| Social Community and Civic Participation | $ | |
| Transport | $ | |
| Capital | $ | |
| Assistive Technology | $ | |
| Home Modifications | $ |
If you could, please also arrange to have me dialled in for the Case Conference.
My number is [contact number].
Please let me know if you require any further information.
I look forward to hearing from you.
Kind regards
[Case Manager email signature]
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4.2 Annexure B – Introductory email to a self-represented Participant or Prospective Participant
- TO: Participant or Prospective Participant
- Subject: Case Manager Introduction – [Participant or Prospective Participant Name] and NDIA – [ART Proceeding Number] – LEXD [LEX No.]
Hello [Participant or Prospective Participant name],
[Delete if not applicable] Thank you for your time on the phone today.
I am a Case Manager in the Administrative Review Tribunal Case Management Branch of the NDIA, and I will be your primary point of contact within the Agency in relation to [your / participant or prospective name] application to the ART.
[Delete if not applicable] I have taken over carriage and conduct of [your / participant or prospective name] matter from [previous CM name], who I understand you were in contact with previously.
If you have any questions or concerns at this time, please feel free to contact me on the details below.
Kind regards
[Case Manager email signature]
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