3 steps to take before starting a NDIS appeal

Written by:
Angela Cox

Angela Cox

Principal Lawyer

In this article:

Aaagh! The NDIS has got it wrong!

Disappointed that the National Disability Insurance Agency (NDIA) has rejected your family member’s application to access the NDIS? Confused about why the funding in their new plan has been cut? Angry that the NDIA has not agreed to fund urgently-needed supports after you went to the effort of making a ‘Change of Circumstance’ or ‘Change of Situation’ request? 

On top of these negative emotions, you may feel powerless, or unsure of what, if anything, you can do to change the decision so that your loved one can get the supports they need. Or you may be vaguely aware that the NDIS has an appeals process, but just the thought of another bureaucratic battle exhausts you! 

The good news is that taking the three easy steps below may quickly resolve your issue, and without a potentially long and stressful NDIS appeal.

Step 1 – Get clear on the NDIS decision

Read the decision a few times to ensure that you understand it. Contact the NDIA (telephone 1800 800 11 or email enquiries@ndis.gov.au) or your Local Area Coordinator (LAC) and ask them to explain the decision to you.

If the decision is about a plan, make sure you fully understand what is funded, and, if applicable, the flexibility the NDIA allows in the spending of the Core and Capacity Building portions of the plan budget. If you have a Support Coordinator, ask them to explain these arrangements to you.

Step 2 – Ask the NDIA to provide detailed, written reasons for their decision

The NDIA uses ‘template’ or standard letters to communicate their decisions, containing generic language. As such, these letters usually do not explain in detail how and why the NDIA made their decision on your individual circumstances. This lack of a detailed explanation is often the source of frustration and confusion.

However, the principles of administrative law give a person affected by a government decision the right to receive reasons for the decision. This underpins the values of transparency and accountability of good government, and reflects the growing public expectation that bureaucratic decisions be justified. 

In practice, this means that you can write to (or email) the NDIA (as soon as possible and preferably within 14 days of receiving the decision) and ask them to provide you, within 14 days, the detailed reasons for the decision-maker’s decision including their: 

  • findings on material questions of fact; 
  • the evidence or other material on which those findings were based; and 
  • the reasoning that led to their decision.  

You can also seek reasons from the NDIA online via their Participant Information Access Request process.

Step 3 – Consider the reasons

Once you have received, and understood, the NDIA’s more detailed explanation for their decision, hopefully it will make sense and be acceptable to you. 

In the case of an access or plan decision, the NDIA’s detailed explanation may shed light on what additional medical or other evidence is required to support your claim. This may help you to decide on next steps. 

For example, the NDIA may have declined an access decision because there was insufficient specialist evidence to support a diagnosis of disability, or the permanency of that disability. Or perhaps the evidence provided was very out of date. Rather than appeal the decision, the better option may be to obtain the evidence the NDIA has indicated is required, and then resubmit the access application including this further evidence. 

On the other hand, reading the NDIA’s detailed explanation may have you tearing out your hair (again!). It may convince you that the NDIA has most certainly not understand your family member’s situation and has made a wrong or unfair decision.

At this point, you may consider starting the ‘NDIS appeals’ process. You can read my quick rundown of the NDIS appeals process here.

How Special Voices can help you

Receiving a negative NDIS decision can cause anger at the seeming injustice (or perhaps stupidity) of the decision, and stress as you brace yourself for yet another battle with bureaucracy to get the supports your family member needs.

As a professional advocate and lawyer with NDIS experience, I can assist you by:

  • helping you to understand the NDIA’s negative decision; 
  • providing a plain English and clear explanation of your legal rights under the NDIS and other laws;
  • developing a strategy for resolving the issue that is based on the NDIS and other laws, and which aims to resolve your problem in the most efficient and fair way; and
  • represent you in dealings with the NDIS to resolve the issue.

Having me ‘fight the battle’ with you, will ensure that your family gets the best outcome with minimal stress.

Read more about Special Voices’ NDIS legal services here.

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DISCLAIMER: The information provided in this article is general only. While it may provide guidance on a issue or matter that you may have, it should not be relied on as legal advice. We recommend that you obtain legal advice specific to your issue or matter.

© A. Cox 2024
All rights reserved. This article is copyright. Apart from any fair dealing for the purpose of private study, research or as permitted under the Copyright Act 1968 (Cth), no part of this article may be reproduced or copied in any form or by any means without prior permission from the author.