Case Management Guide
Supportable Impairments
| Field | Category | Reference Documents |
|---|---|---|
| Title | Supportable Impairments | |
| 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). This Guide applies nationally to the conduct of all matters within the Administrative Review Tribunal Case Management Branch. | |
| Scope | A participant’s impairment and associated disability can permanently and substantially reduce their functional capacity or their ability to undertake activities. For the purposes of this document, an impairment can be: * intellectual; * cognitive; * neurological; * sensory; * physical; or * an impairment to which a psychosocial disability is attributable. | Section 24 of the National Disability Insurance Scheme Act 2013 |
| Operational Guideline – Applying for the NDIS | ||
| Do you meet the disability requirements? | ||
| Does your impairment substantially reduce your functional capacity? | ||
| Do you have an extreme functional impairment or very high support needs? | ||
| NDIA policy on this subject | The ART process is often seen as stressful and adversarial by participants and prospective participants of the Scheme. The NDIA will adopt a participant-focused approach to resolving disputes before the ART, and will work directly with participants and prospective participants to provide better and earlier outcomes, where possible. | |
| The role of the NDIA is to assist the ART in reaching the correct and preferable decision, including by assisting participants and prospective participants in reaching the best possible resolution by agreement. Participants are generally ineligible to receive NDIS funding if: | NDIA Dispute Resolution Policy | |
| Appendix B to the Legal Services Directions 2017 | ||
| Section 24 of the National Disability Insurance Scheme Act 2013 | ||
| List B: Conditions that are likely to result in a permanent impairment |
Case Management Guide
Supportable Impairments
| Field | Category | Reference Documents |
|---|---|---|
| - their impairment is temporary; or - their impairment is treatable, whether treatment is ongoing or whether there are unexplored treatment options available to the participant. The NDIA is also unable to fund supports which would more appropriately be funded by other mainstream service delivery systems. |
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| NDIA posture in relation to this subject | Whether the NDIA is able to offer support funding in relation to a particular impairment will typically hinge on whether or not: - the impairment is, or is likely to be, permanent; and - whether the support needed is most appropriately funded by the NDIA. Where the engagement with health is aimed at curing the impairment, the NDIS would not provide supports. A person can have engagement with the health system and still require disability supports that work alongside the health system’s management of permanent impairments. |
Operational Guideline – Applying for the NDIS Section 25 of the National Disability Insurance Scheme Act 2013 |
| Evidence recommended to inform NDIA position in a matter before the ART | The primary concern of the NDIA is the participant’s wellbeing. The NDIA will rely on the available evidence and best practice when considering whether a participant is entitled to receive funding from the NDIA for a particular impairment. The NDIA will refer to evidence from health and allied health providers, expert evidence, opinion evidence and witness statements. The NDIA will also closely consider a participant’s daily support needs as a result of their impairment when considering the appropriate level of funding to provide, wherever possible. |
Providing evidence of your disability Persons Giving Expert and Opinion Evidence Guideline Administrative Review Tribunal |
| Other considerations | Some participants may have an impairment which will improve over time, meaning that the participant will require progressively less disability support over time. | Do you need early intervention? |
NDIA-ART CM-GDE-001-FINAL OFFICIAL Page 2 of 3 Page 5 of 9
Case Management Guide
Supportable Impairments
| Field | Category | Reference Documents |
|---|---|---|
| In those circumstances, participants may be eligible to receive early intervention support funding. In those circumstances, the NDIA will consider: - whether the impairment is likely to be permanent; - whether early intervention supports are likely to reduce the need for future supports; and - whether the early intervention needed is an NDIS support | Sections 24, 25 and 27 of the National Disability Insurance Scheme Act 2013 | |
| Rule 6.9 of the National Disability Insurance Scheme (Becoming a Participant) Rules 2016 | ||
| Case Management Guide – Access to the NDIS | ||
| Previous matters that may inform the NDIA position | The question is not whether the impact of a participant’s impairment is significant in general terms, or whether a support js actually funded by another mainstream service delivery system. Instead, the test is whether or not the legislative requirements are met; which is to say, whether a participant’s impairment is permanent and substantially reduces their functional capacity, and whether or not support funding in relation to that impairment is most appropriately provided by the NDIA, and not another mainstream service delivery system. | |
| The AAT affirmed a decision of the NDIA on the basis that it was not satisfied these legislative requirements were met, on the available evidence. | Allen and National Disability Insurance Agency [2018] AATA 3851 |
| Document Control | Responsible Person | Date |
|---|---|---|
| Document author | Continuous Improvement | October 2024 |
| Document approver | Director, Continuous Improvement | 28 October 2024 |