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Understanding an internal review

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DOCUMENT 26

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Knowledge Article

For Internal Use Only The contents of this document are OFFICIAL.

Understanding an internal review

Guidance in this document is not approved for use unless you view it in PACE.

This article provides guidance for all NDIA staff and partners to understand:

  • what is a request for an internal review
  • who can submit a request for internal review
  • when an internal review request can be submitted
  • what happens once a request for internal review is submitted
  • how internal review requests are prioritised.

Recent updates

6 May 2024

Minor update to reflect the renaming of roles in the Review Branch.

What is a request for an internal review

If an applicant or participant is unhappy with a NDIA decision, they can ask us to review our decision.

This is called an internal review. The Reviews Branch manages internal reviews.

A delegate who was not involved with making the original decision will complete the internal review. The Review Officer considers the evidence and information related to the decision, then decides to either:

  • set aside the original decision (make a new decision)
  • vary the original decision (make some changes)
  • confirm the original decision (don’t make any changes).

The most common decisions subject to review are:

  • Access not met (s 99 (1) - 1). A person requests access to the NDIS, but we decide they don’t meet the access criteria to become a participant.

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  • Access revoked (s 99 (1) - 3). A person was once a participant of the NDIS but had an eligibility review and was found not to meet the access criteria, so their status as a participant was revoked.
  • Statement of supports (s 99 (1) - 4). A participant is unhappy with the NDIS funded supports in the approved plan, the plan duration or the plan management decision.
  • Not to review a plan (s 99 (1) - 6). The participant has requested a participant requested plan reassessment under s48(2) of the NDIS Act and the NDIA decided not to conduct that plan reassessment.

Not all NDIA decisions are reviewable. The list of reviewable decisions is under section 99 of the NDIS Act (external).

You can learn more in Our Guideline - Reviewing our decisions (external)

Who can submit a request for internal review

A directly affected person with authority can request an internal review.

For most cases relating to a participant, a directly affected person can be:

  • an applicant that has been deemed access not met or access revoked
  • a participant or formally recognised plan nominee or child representative that does not agree with a reviewable decision about their plan
  • a person affected by a decision to appoint, not appoint, suspend or revoke nominee or child representative status

Other directly affected persons can include:

  • providers affected by a NDIA decision specifically relating to a provider
  • a person affected by a NDIA decisions relating to debts

A person with valid authority or consent may request internal review on the behalf of a directly affected person. Authority can take the form of valid child representative, plan nominee or guardian permissions. Otherwise, we need consent from the directly affected person, preferably in writing. This could include:

  • a consent form signed by the directly affected person
  • an email confirming the directly affected person giving their consent to lodge the review

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  • an internal note documenting a telephone conversation with the directly affected person where they provided consent.

You can learn more in Our Guideline - Your privacy and information (external).

A directly affected person or their representative can submit a request internal review using the Request for a Review of a Decision form (external). They can also ask in person or on the phone, or by sending a request by letter or email.

When an internal review request can be submitted

A request for an internal review must be made within 3 months of receiving the original reviewable decision. If a person requests an internal review more than 3 months after the date they receive the original reviewable decision, we cannot conduct an internal review.

We may need more evidence or supporting documentation to consider a request for additional supports. This should be communicated to the requestor when submitting an internal review request.

To create an internal review, refer to Create an internal review (s100) case.

What happens once a request for internal review is submitted

When an internal review request is submitted, PACE sends an automated acknowledgement letter using the preferred communication method to confirm we’ve received the request.

If the review request is not considered valid, the Reviews Branch will discuss other options and next steps with the person who requested the review. This may be because the request was lodged by an unauthorised person, doesn’t relate to a reviewable decision, or was submitted more than 3 months after the original decision.

If the request is valid, the request will be assigned to a Review Officer.

The Review Officer will contact the person who requested the review to acknowledge the request and to clarify aspects of the internal review.

The Review Officer will review the facts, laws and NDIA policies related to the original decision and determine what the correct or preferable decision is. The Review Officer will also consider any new information provided.

The Review Officer aims to complete the internal review within 60 days as outlined in the Participant Service Guarantee (external). The Review Officer will provide the outcome and reasons for the internal review decision in writing.

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How internal review requests are prioritised

If the Reviews Branch determines the applicant or participant is at high or extreme risk based on the NDIA’s Escalation and Prioritisation Matrix, the internal review will be assigned to a Review Officer as a priority. The IRT will prioritise requests based on the highest category of risk that applies based on the requestor’s circumstances.

The Reviews Branch will contact the requestor within 48 hours of escalation to confirm that their request was prioritised. They will also gather any relevant information needed to complete the review.

For more information, refer to article Escalating a request for internal review (s100).

Article labels — internal use only

PACE user role names

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dc_users_accessdelegate, dc_users_bereavementofficer, dc_users_businesssupportofficer, dc_users_complaintsofficer, dc_users_compensationdelegate, dc_users_earlychildhoodpartner, dc_users_engagementofficer, dc_users_enrolmentofficer, dc_users_externalreviewofficer, dc_users_fraudofficer, dc_users_freedomofinformationofficer, dc_users_homeandlivingdelegate, dc_users_legalofficer, dc_users_liaisonofficershlo/jlo, dc_users_localareacoordinator, dc_users_nationalcontactcentre, dc_users_participantcriticalincidentsofficer, dc_users_participantsupportofficer, dc_users_paymentsofficer, dc_users_plannerdelegate, dc_users_qualityofficer, dc_users_reviewofficer, dc_users_supportingofficer, dc_users_technicaladvisors, dc_users_plannernonpartneredarea

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Version control

Version Amended by Brief Description of Change Status Date
2.1 JNL620 Updated to reflect new user role and team designation. DRAFT 2024-03-26
2.2 SGH107 Peer Review DRAFT 2024-03-26
2.3 JNL620 Adjusted for peer review DRAFT 2024-03-26
2.4 JNL620 Adjusted for VT
VT Result
Number of long sentences: 17
(15.32%)
Number of passive sentences: 21
(18.92%)
Readability: 33
Grade Level: 10.8		 DRAFT 2024-03-28
2.5 EJW711 EL1 review DRAFT 2024-04-02
2.6 JNL620 Adjustments for EL1 review DRAFT 2024-04-23
3.0 JS0082 Class 1 Approval APPROVED 2024-04-29

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