Last updated 1 June 2025

A person can apply to access the National Disability Insurance Scheme (NDIS) by downloading and completing an ‘access request form’ and sending it, along with supporting evidence (see below for what evidence is required), to the National Disability Insurance Agency (NDIA).

A person will be eligible to access the NDIS (and become a participant) if they:

  • are under 65 years of age at the time they lodge their access request
  • live in Australia and are an Australian citizen, permanent resident or protected special category visa holder
  • meet the ‘disability requirements’ and/or ‘early intervention requirements’ (s 21 NDIS Act).

The criteria for the disability requirements and the early intervention requirements are different.

To meet the disability requirements, a person must show:

  • they have an impairment that is permanent (or likely to be permanent) and
  • the impairment results in the person having a substantially reduced capacity to undertake certain activities of daily life and
  • the impairment impacts their ability to engage in employment and/or the community and
  • they will be likely to require support for their lifetime (s 24 NDIS Act).

To meet the early intervention requirements, a person must show:

  • they have an impairment that is permanent (or likely to be permanent) or they are a child under six years of age with a developmental delay and
  • the provision of early intervention supports (that are NDIS supports)is likely to reduce their future need for support and
  • the provision of early intervention supports will likely benefit them in one or more specified ways (s 25 NDIS Act).

When a person is approved by the NDIA as meeting the access criteria, they should be given a written notice that states whether they meet the disability requirements, the early intervention requirements or both sets of requirements (s 28 NDIS Act).

Most commonly, people experience difficulty in accessing the NDIS due to a failure to establish their impairment is permanent (as required by both ss 24 and 25 of the NDIS Act) and/or a failure to establish their impairment impacts them to such an extent that their capacity to undertake activities of daily living is substantially reduced (as required by s 24 of the NDIS Act).

In all cases, evidence from independent sources, such as medical specialists and allied health professionals, is required.

What is an impairment?

Impairments may be:

  • intellectual (impacting how a person thinks)
  • cognitive (impacting how a person concentrates, remembers information and makes decisions)
  • neurological (impacting how a person’s nervous system works)
  • sensory (impacting a person’s senses such as hearing and seeing)
  • physical (impacting a person’s ability to move parts of their body)
  • psychosocial (associated with a diagnosis such as anxiety or depression).

The Federal Court of Australia in Mulligan and National Disability Insurance Agency [2015] FCA 544 noted the term impairment involves the ‘… loss of or damage to a physical, sensory or mental function’, and confirmed the NDIS Act requires an assessment of a person’s impairment/s, not the person’s underlying diagnoses or conditions (how the person came to have the impairment/s).

It is advisable for applicants to the NDIS to list and describe all impairments with which they live in their requests to access the NDIS. This is because supports may only be funded through the NDIS if they are needed, at least in part, because of an impairment that has been accepted by the NDIA as meeting the disability or early intervention requirements (see below for more detail regarding this requirement under s 34(1)(aa) of the NDIS Act).

Successful applicants to the NDIS are provided with an ‘impairment notice’, which lists the category or categories of impairment on which the NDIA has based its decision to grant access to the NDIS.  A person can request a variation of an impairment notice (if, for example, the person has multiple impairments but the NDIA has only recognised one impairment). A decision to refuse to vary an impairment notice is reviewable (ss 32BA, 99 item 3A NDIS Act).

When is an impairment permanent?

An impairment will be considered permanent (or likely to be permanent) when there are no known, evidence-based treatments available that will likely remedy the impairment/s (rr 5.4–5.7 Becoming a Participant Rules).

The Federal Court of Australia in National Disability Insurance Agency v Davis [2022] FCA 1002 interpreted the meaning of the words ‘available’ and ‘remedy’:

  • A treatment (e.g. surgery, medication, psychological and physical therapy) will be ‘available’ if it is available to the person. If there is a treatment that a person cannot access because it is only available overseas, or is unaffordable for them, then it is arguably not available to them.
  • A treatment will ‘remedy’ an impairment if it substantially relieves or cures it. In Ms Davis’s case, the court noted that ‘… the word ‘remedy’ should be understood to mean something approaching a removal or cure of the impairment’. If a treatment merely helps a person manage the day-to-day impact of their impairment, then this is not a remedy (see also for example MHZQ and National Disability Insurance Agency [2019] AATA 810 [67]-[72], in which the Administrative Appeals Tribunal (tribunal) noted that although the applicant’s mobility may improve with weight loss, it would not remedy the applicant’s bilateral knee impairment).

A fluctuating or episodic impairment may be permanent despite the changeable nature of the impairment (ss 24(2), 24(3), 25(1A) and see for example the v Davis case above, in which the court noted that while the impact of an impairment on a person might fluctuate from time to time, the impairment will be permanent if it ‘endures’.)

Evidence of permanancy

Generally, it is insufficient for a medical practitioner to state that the impairment is permanent.  Rather, the medical practitioner will need to provide detailed information about past treatments considered and/or trialled, current treatments and any future treatments, their availability to the person and the likely outcome of those future treatments.

In the absence of one detailed report regarding the treatment of a person’s impairment, evidence collected over time that demonstrates the longevity of a person’s impairment and continued symptoms despite treatment may be sufficient to rely on as evidence of permanency (see KDYG and National Disability Insurance Agency [2019] AATA 3411 (10 September 2019) (at [26]–[28]), a case which concerned a person with long-standing mental health conditions).

If medical letters or reports provided to the NDIA suggest additional treatment is open to a person (e.g. via a referral to a therapist), it will be important for the person to demonstrate, via the provision of a further letter or supplementary report, that the suggested treatment has been explored and/or trialled but will not remedy their impairment, if that is the case.

See  MacFarlane and National Disability Insurance Agency [2018] AATA 4727, in which the tribunal concluded Mr MacFarlane’s chronic pain impairment was not permanent because there was evidence that he had started a multidisciplinary pain treatment program but stopped the program before it was finished. A further report by Mr MacFarlane’s pain specialist explaining that even if Mr MacFarlane had completed the program, the benefits were limited to helping Mr MacFarlane manage his day-to-day symptoms (and not substantially relieving them), may have addressed this evidentiary gap.

What is a substantial reduction in functional capacity?

A person will have a substantial reduction in functional capacity if they usually require help from others or are dependent on equipment (other than commonly used items), technology or home modifications in order to completely and effectively undertake activities of daily life (r 5.8 Becoming a Participant Rules).

See Mulligan and National Disability Insurance Agency [2015] AATA 974 (17 December 2015), in which Mr Mulligan failed to establish he had a substantial reduction in functional capacity to mobilise because Mr Mulligan’s evidence is that he can undertake these activities without assistive technology, equipment other than a walking stick or home modification. He is able to safely complete these tasks or activities within an acceptable time period even if he does so more slowly or in a different manner from others. He does not usually require assistance from other people to mobilise.

Activities of daily life are categorised into the following areas:

  • mobility—moving physically within and outside of the home
  • communication—expressing needs, being understood and understanding others
  • learning—possessing skills required to learn, including concentration and memory
  • social interaction—making and keeping relationships and interacting with others in the community
  • self-care—maintaining personal hygiene, grooming, feeding and health care
  • self-management—having the capacity and skills required to take responsibility for oneself, including making decisions, planning, managing and organising daily tasks, finances and accommodation.

A person will need to demonstrate they have a substantial reduction in functional capacity in at least one area of daily life, and not merely with one task. See National Disability Insurance Agency v Foster [2023] FCAFC 11, in which the court found that Mr Foster, who relied on a catheter to void his bladder and could otherwise bathe, groom, dress and feed himself, did not have a substantial reduction in his functional capacity to undertake the activity of self-care.

Just because a person may cope somehow without help from others, equipment, technology or home modifications does not mean they do not require that help. See KDYG and National Disability Insurance Agency [2019] AATA 3411 (10 September 2019), in which the tribunal noted (at [87]) ‘… that the Applicant struggled and survived before having the current level of assistance does not persuade the Tribunal that she does not require the assistance she is currently receiving’.

What qualifies as specialist disability equipment has been considered in the following cases:

  • In Beaumont and National Disability Insurance Agency [2024] AATA 891, Mr Beaumont used a light-weight aluminum folding chair, purchased from Kmart, to help him access the community, pausing every now and then and sitting on the chair to help him manage his pain and fatigue. The tribunal found that although the chair was not a walker prescribed by a medical practitioner, it could be classified as disability equipment as it was being used by Mr Beaumont ‘… to improvise for equipment that is assistive in nature like a walker’.
  • In Gardner and National Disability Insurance Agency [2023] AATA 1287, the tribunal concluded that Mrs Gardner’s walking stick, which she used inside her home, was a commonly used item but her walker, which she used outside, was specialist disability equipment. Because Mrs Gardner was always reliant on her walker outside her home (meeting the minimum threshold of ‘usually’) she had a substantially reduced functional capacity in the area of mobility.

The NDIS Operational Guidelines purport to limit specialist disability equipment to that which is prescribed by a doctor, allied health professional or other medical professional, however, the tribunal has found this is inconsistent with the law (see Pallier and National Disability Insurance Agency [2024] AATA 157 (at [100])).

Evidence of function

Statements of lived experience by the person with disability and their friends and/or family are helpful to paint a picture for the NDIA about the person’s capacity to undertake activities of daily life. The more detail that can be incorporated into the statements, including examples of help the person requires, the better.

Where a person’s functional capacity changes over time, it is important to include detail within statements and/or diary notes of the person’s good and bad days, and note their frequency. Variation in functional capacity was considered in the following cases:

  • In Baranowski and National Disability Insurance Agency [2023] AATA 1701, the tribunal found that while Ms Baranowski’s difficulties were more intense on days she was experiencing severe psychological symptoms, the symptoms appeared to be present all the time, and the tribunal concluded Ms Baranowski had a substantially reduced functional capacity to undertake the activity of social interaction.
  • In Galea and National Disability Insurance Agency [2022] AATA 2263, the tribunal found Mr Galea’s bad days were relatively infrequent, only one every two months, and his function between them, while impaired due to his complex regional pain syndrome, was not substantially reduced.

While detailed lived experience statements are helpful, prospective NDIS participants will also generally need to provide a report by a health professional (typically an occupational therapist)  who has undertaken a functional capacity assessment of the person or who can otherwise objectively comment on the person’s capacity to undertake activities of daily life, based on direct observation. The expense of a comprehensive functional capacity assessment and report can be prohibitive for some people seeking access to the NDIS. In these cases, information about the person’s functional capacity can be provided  from the person, their carers and/or their GP, and if the person’s application to access the NDIS is refused, an occupational therapist may be engaged (and paid for) by the NDIA to do a functional capacity assessment on review, when there is generally opportunity to gather further evidence (see below for more detail).

Access via the early intervention requirements

Access to the NDIS based on the early intervention requirements is available to both children and adults.

Young children (under six years of age) who have been diagnosed with developmental delay do not need to demonstrate their impairment is permanent and do not need to provide evidence regarding the benefit of early intervention supports (rr 6.8–6.11 Becoming a Participant Rules).

For everyone else, access to the NDIS via the s 25 of the NDIS Act early intervention requirements should be considered where a person is unlikely to satisfy the NDIA that they experience a substantial reduction in functional capacity, as required by the s 24 of the NDIS Act disability requirements. The person may be eligible to access the NDIS if they can instead demonstrate that intervention (e.g. psychological or physical therapy that would qualify as NDIS supports) will likely:

  • reduce the person’s future support needs and
  • lessen the impact of their impairment or
  • improve or prevent a deterioration of their functional capacity or
  • strengthen the sustainability of their informal supports.

‘Early’ does not relate to the timing of a person’s diagnosis, but rather the onset of the person’s impairment/s. A person who has a long-standing diagnosis, including a diagnosis of a degenerative condition, may be eligible to access the NDIS via the early intervention requirements if the impairments that flow from the diagnosis are at an early stage. This was considered by the tribunal in the case of James and National Disability Insurance Agency [2019] AATA 4248 (18 October 2019), in which the tribunal noted that ’… the early intervention requirements look at the likely trajectory and impact of a person’s impairment over time and the potential benefits of early intervention on the impact of the impairment on the person’s functional capacity’ (at [49]).

There are few reported decisions regarding access to the NDIS via the early intervention requirements  (see Van Hout and National Disability Insurance Agency [2023] AATA 2771), however, following amendments to the NDIS Act in 2024, which require the NDIA to provide written notice to eligible applicants regarding the nature of their access (via the disability and/or early intervention requirements), it is likely that access to the NDIS via the early intervention requirements will increase.

Streamlined access for people diagnosed with certain conditions

The NDIA has published lists of conditions within their Operational Guidelines that enable a streamlined access process for people diagnosed with certain conditions.

People diagnosed with a List A condition will be likely to be accepted as meeting the disability requirements without further assessment. People diagnosed with a List B condition will be likely to be accepted as having an impairment that is permanent and will only require assessment in relation to the remaining criteria concerning the impact of their impairment and need for support from the NDIS throughout their lifetime. Children under seven years of age diagnosed with a condition on List D will be accepted as meeting the early intervention access requirements without further assessment.

It is therefore important to review these lists in the first instance to avoid unnecessary assessments in cases where a streamlined option is available to the person seeking access to the NDIS.

Revocation of participant status

Sections 30 and 30A of the NDIS Act allow the NDIA to revoke a participant’s status if the NDIA considers the person no longer meets the access criteria.  These sections empower the NDIA to request information from a participant and/or undergo an assessment, and if the participant unreasonably fails to comply with a request, their NDIS participant status may be revoked. If a person receives an information or assessment request in relation to their participant status from the NDIA, it should be acted on promptly and legal advice and/or advocacy support should be sought (see Free Advocacy and Legal Services).

A decision to revoke a participant’s status is a reviewable decision (see How to Appeal a National Disability Insurance Agency Decision) and, as seen in the case of Stephan-Miller and National Disability Insurance Agency (Practice and procedure) [2025] ARTA 43, is a decision that can be stayed to enable a person continued access to NDIS supports pending the determination of the review application. In the Stephan-Miller case, the tribunal granted a six-month stay of the decision so the applicant could continue to receive NDIS-funded supports, noting:

‘The NDIS Act is beneficial legislation which is intended to confer a benefit on the Applicant if she is qualified to receive such a benefit. Removal of such benefits in their entirety is a matter to be approached with good procedure and solid evidence … The impact of the loss of services on a vulnerable person with a disability or medical conditions is serious and has a much greater impact on their health and quality of life than the continued provision of those services on an interim basis to a single individual would have on the Respondent’(at [52]).