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Standard Operating Procedure: Early Assessment

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DOCUMENT 6 FOI 24/25-1246 OFFICIAL For Internal Use Only

National Disability Insurance Agency Legal, Reviews, Actuarial and Data Group

Standard Operating Procedure: Early Assessment

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Document Control

Document No. NDIA-ERB-SOP-027 Date April 2025 Status DRAFT Version 001 Document applicability National – Legal, Reviews, Actuarial and Data Group Owner Director, Continuous Improvement

Approval Status Log

Version 001 Reviewed by Director, Early Assessment Special Counsel, Dispute Resolution Endorsed by Branch Manager, External Review Branch Deputy Chief Counsel, Dispute Resolution & Litigation Branch Branch Manager, Information Release, Privacy and Legal Operations Branch Approved by NDIA Strategic Leadership Team Approval date

Revision History

Revision Date Sections Summary of Changes

Original 1 All (formerly NDIA-AAT CM-SOP-027)

Note: Document uncontrolled in hardcopy

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FOI 24/25-1246 OFFICIAL For Internal Use Only Contents

  1. Introduction 4 1.1 Purpose 4 1.2 Scope 4 1.3 Definitions 4 1.4 Roles and Responsibilities 4
  2. Checklist 5
  3. Procedure 7 3.1 Allocating matters to EA 7 3.2 Allocating matters to an EA CM and ILO 7 3.2.1 Matters which are likely to resolve at the time of first contact 7 3.3 Creating an EA Module in LEX 7 3.4 Creating a key date reminder in LEX 8 3.5 Initial review of the matter by EA CM 8 3.6 Contacting the participant or prospective participant 9 3.6.1 Determining a person’s preferred contact method 9 3.7 Receipt of legal advice and litigation strategy 9 3.8 Requesting internal specialist advice 10 3.9 Gathering further evidence 10 3.10 Determining whether a matter can be resolved 10 3.11 Resolving a matter 11 3.11.1 Developing and approving an offer to resolve the matter 11 3.11.2 Presenting an offer to a participant or prospective participant 11 3.11.3 Where an offer is not accepted, or where no response is received 11 3.11.4 Where an offer is accepted 12 3.11.5 Implementing an ART Order 12 3.12 Where the matter cannot be resolved 12 3.12.1 Where further evidence is required to resolve a matter 13 3.13 Returning matters to Legal Operations for reallocation to DR 13 3.13.1 Matters which are unsuitable for Early Assessment 13 3.13.2 Matters which cannot be resolved 14
  4. Process Flowchart 16
  5. Annexures 17

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5.1 Annexure A – Email Templates 17 5.1.1 Annexure A1 – Introductory email to a participant, prospective participant, or their representative 17 5.1.2 Annexure A2 – Email presenting an offer to resolve the matter 19 5.1.3 Annexure A3 – Email to a participant or prospective participant when a matter is transferred to DR Case Management 20 5.2 Annexure B – EA Module Fields and Definitions 21

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  1. Introduction

1.1 Purpose

This Standard Operating Procedure provides general information about the Early Assessment (EA) process, and offers tailored support and guidance to EA Case Managers in managing applications to the Administrative Review Tribunal (ART).

1.2 Scope

This SOP applies nationally across the External Review Branch (ERB), the Dispute Resolution and Litigation Branch (DR&L), and the Information Release, Privacy, and Legal Operations Branch (IRPLO) and is to be used by: • Early Assessment Case Managers (EA CM); • Internal Legal Officers (ILO); and • Legal Operations Officers.

1.3 Definitions

TABLE 1 – TABLE OF KEY DEFINITIONS

Term Definition

Early Assessment (EA) The process of assessing ART Applications with a primary focus on reaching and facilitating early resolution outcomes (where possible), and on enhancing participant and prospective participant experience by providing information about NDIS supports and the ART process – before the matter proceeds to Dispute Resolution (DR).

1.4 Roles and Responsibilities

The roles and responsibilities set out in the Standard Operating Procedure: Document Control Procedure apply also to this procedure.

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3.9 Gathering further evidence

The EA CM will continue to work with the participant or prospective participant (and/or their representative) and the LWC to gather and consider additional evidence, to support early resolution of the matter where possible. The EA CM will seek the consent of the participant or prospective participant to obtain further evidence – which may include posing targeted questions to the person’s treating practitioner, or engaging an Independent Expert Clinician (IEC). s22(1)(a)(ii) - irrelevant material

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3.12.1 Where further evidence is required to resolve a matter

Where further evidence is required to resolve a matter, and where it would be appropriate to engage an IEC – the EA CM will work with the participant or prospective participant, the LWC, and TAPIB to identify a suitable IEC, and to determine a series of targeted questions for consideration by the IEC. The EA CM has a responsibility to ensure that the litigation strategy prepared by the LWC accurately reflects the Agency’s position around the appropriateness of engaging an IEC, as well as the questions to be considered by the IEC. s22(1)(a)(ii) - irrelevant material

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  1. Process Flowchart

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