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Case Management Guide

Decision Making

DOCUMENT 6

Field	Category	Reference Documents
Title	Decision Making
Purpose	This document is part of a suite of guidance documents for Case Managers to use in formulating their approach to managing individual matters before the Administrative Review Tribunal (ART).	Decision-Making Authority for Case Managers
Scope	This Guide applies nationally to the conduct of all matters within the External Review Branch.
Making Decisions	Good decision making is evidence-based, factual, consistent, applies the legislative framework, and is logical. Objectively, a good decision: ✓ is evidence-based if it explicitly and judiciously considers the best available evidence; ✓ is factual if it accounts for the facts which are unique to the matter, and to the participant or prospective participant; ✓ is consistent and fair if it aligns with the Model Litigant Obligations and NDIA policy framework; ✓ applies the legislative framework if it explicitly and judiciously considers the specific criteria prescribed by the Act and the Rules; and ✓ is logical if it is clear, and well-informed by the available evidence, the facts, and the law.	NDIS Act 2013 NDIS Rules NDIA Dispute Resolution Policy Part 5, Division 2 to the Legal Services Directions 2025 Section 56 of the Administrative Review Tribunal Act 2024 Case Management Guide: Model Litigant Obligations External Review Branch Guidance Library and Directory
Recording Decisions	Case Managers must record all decisions as a file note in LEX. A well-recorded decision objectively defines: ✓ what decision is made; ✓ under what authority the decisions is made — including where a decision is supported by legal or internal specialist advice, and has been reviewed by an Assistant Director, Director, Pre-ALOC or ALOC; and ✓ what evidence is relied upon to form the basis of that decision (and whether that evidence is new or existing evidence).	Decision-Making Authority for Case Managers Standard Operating Procedure: Resolved by Consent

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Case Management Guide

Decision Making

Field	Category	Reference Documents
	Example file notes are contained at Annexure A — File Note Examples.

Annexure A — File Note Examples

While not prescriptive, the below examples are indicative of the minimum standard which is to be expected of Case Managers when recording a decision as a file note in LEX. At a minimum, Case Managers are expected to identify what the decision is, under what authority the decision is made, and what evidence is relied upon in making that decision (including any new or existing evidence).

The below examples are based on the Updated Position file note template in LEX.

Example 1

Support(s) in dispute:

1. 28 days per year (24 hours per day) Assistance with Self-Care Activities, comprising: a. 16 hours per day of 1:1 support worker assistance; and b. 8 hours per day of 1:1 inactive overnight support;
2. $1,425.78 per year for Nutritional Supplements; and
3. Transport Level 1.

Evidence (new or existing):

• OT report dated 26/05/2023 (new)
• Supplementary OT report dated 5/06/2023 (new)
• Letter from Gastroenterologist dated 29/04/2023 (new)
• Letter form Dietitian dated 18/04/2023 (existing)

Authority:

• External legal advice received on 31/05/2023 (Nutritional Supplements)
• TAPIB advice received on 22/05/2023 (Transport Level 1)
• TAPIB advice received on 22/05/2023 (24 hours of 1:1 support for 28 days per year)

Case manager decision and next steps:
My decision is to approve all supports, in line with external legal advice and TAPIB advice. Offer to be presented to participant, and s103(2) ToA to be drafted.

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Case Management Guide

Decision Making

Example 2

Support(s) in dispute:

1. STA x 12 days per year (6 x weekends)
2. Funding for linen service x 3 hours per week

Background:

• Participant resides in a granny flat by himself on his mum’s property
• Participant is highly dependent on his mum as his sole carer
• Participant’s mum is experiencing carer burn out
• Participant requires daily support for all ADLs

Evidence (new or existing):

• Statement of lived experience dated 01/07/2023 (existing)
• Carer impact statement dated 01/07/2023 (existing)

Authority:

• ALOC (chaired by DCEO, Governance, Risk and Legal) on 24/08/2023
• Legal advice dated 01/08/2023

Case manager decision and next steps:
My decision is to fund STA to alleviate pressure on the participant’s mum as sole carer and to mitigate any potential risk to the participant. This is unsupported by legal advice received on 01/08/2023, but is supported by ALOC (DCEO Governance, Risk and Legal). Offer to be presented to participant, and s85(1) ToA to be drafted to narrow the issues in dispute prior to potential Hearing.

Further information to be obtained in relation to the request for funding for linen service x 3 hours per week, noting the participant is still seeking this support and will not resolve on the basis of the above offer. ALOC supported maintaining the Agency position that funding for linen service x 3 hours per week is not reasonable and necessary.

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Case Management Guide

Decision Making

Example 3

Support(s) in dispute:

1. Participant seeks an extension of time (50 days) in which to apply to the ART for review

Evidence (new or existing):

• Application for review of a decision lodged on 01/08/2023 (new)

Authority:

• Standard Operating Procedure: EOT (standing instructions)

Decision and next steps:
My decision is not to oppose the EOT, in accordance with the EOT SOP. Approved by my EL1. I advise the ART that EOT is not opposed. Matter to be triaged, and allocated to EA.

Example 4

Support(s) in dispute:

1. Participant seeks an extension of time (94 days) in which to apply to the ART for review

Evidence (new or existing):

• Application for review of a decision lodged on 01/08/2023 (new)
• Email from the participant’s advocate to the ART dated 01/08/2023 (new)

Authority:

• Legal advice received on 10/08/2023

Decision and next steps:
My decision is to oppose the EOT, in line with legal advice. Approved by my line manager. I will instruct the LWC to advise the ART that the EOT is opposed.

Document Control

Document Control	Responsible Person	Date
Document author	Performance, Policy and Quality	March 2025
Document approver	Director, Performance, Policy and Quality	October 2025

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