Last updated 25 February 2020
A person can apply to access the National Disability Insurance Scheme (NDIS) by calling the National Disability Insurance Agency (NDIA) on 1800 800 110 or by contacting their local area coordinator or local NDIA office. An access request form must be completed and submitted with supporting evidence. This form is not available online and must be requested from the NDIA or local area coordinator.
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 and
- meet the disability or early intervention requirements (s 21 National Disability Insurance Scheme Act 2013 (Cth) (NDIS Act)).
A person will meet the disability requirements if:
- they have a permanent impairment as a result of a diagnosed condition 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).
A person will meet the early intervention requirements if:
- they have a permanent impairment or they are a child under six years of age with a developmental delay and
- the provision of early intervention support is likely to reduce the person’s future need for support and
- the provision of early intervention supports will likely benefit the person (s 25 NDIS Act).
Most commonly, people experience difficulty in accessing the NDIS due to a failure to establish that their impairment is permanent (as required by both ss 24 and 25 of the NDIS Act) and/or a failure to establish that 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 both cases, evidence from independent sources, such as a medical specialist or allied health professional, is generally required.
Evidence required to establish an impairment is permanent
A person will need a letter or report from their general practitioner and/or specialist confirming the nature of their diagnosis, and that there are no available treatments that will likely remedy the impairment the person experiences as a result of that diagnosis (rr 5.4–5.7 National Disability Insurance Scheme (Becoming a Participant) Rules 2016 (Cth) (Becoming a Participant Rules)).
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 treatment options considered and/or trialled (e.g. medication, therapy or otherwise), current treatments and any future treatments and the likely outcome of those treatments (i.e. benefits and risks). This will enable the NDIA to make its own assessment of permanency against this legislative criterion.
The distinction between treatment helping a person to manage their symptoms and treatment remedying an impairment is important (see for example MHZQ and National Disability Insurance Agency  AATA 810 (8 May 2019) –, in which the tribunal noted that although the applicant’s mobility may improve with weight loss, it would not remedy the applicant’s bilateral knee impairment.
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 upon as evidence of permanency (see for example KDYG and National Disability Insurance Agency  AATA 3411 (10 September 2019) –, 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 report, that the suggested treatment has been explored and/or trialled but will not remedy their impairment.
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 for example Mulligan and National Disability Insurance Agency  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 safely to 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. .
See also Arnel and National Disability Insurance Agency  AATA 4778 (18 November 2019), in which the tribunal determined that Ms Arnel could not completely and effectively engage in the activity of showering and therefore had a substantial reduction in functional capacity in the area of self-care.
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 only need to demonstrate that they have a substantial reduction in functional capacity in one of these areas.
To evidence this, statements of lived experience by the person and their friends and/or family will be helpful to paint the 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.
However, self-assessment and reporting will generally not be sufficient. Prospective participants will also need to provide a report by a health professional (e.g. an occupational therapist or psychologist), who has undertaken a functional capacity assessment of the person or who can otherwise objectively comment on the person’s capacity based on direct observation.
Just because a person may cope somehow without help from others, equipment, technology or home modifications does not mean they do not require assistance to participate in activities of daily living. See KDYG and National Disability Insurance Agency  AATA 3411 (10 September 2019), in which the tribunal noted ‘… 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. ’.
Section 8.3 of the Access to the NDIS Operational Guideline provides additional guidance as to what may be a substantial reduction in functional capacity, including ‘… reliance on equipment means specialist disability equipment and not commonly used items (such as a walking stick, non-slip bath mat, grab rails, child-safety locks, and stair rails)’.
See Ditchfield and National Disability Insurance Agency  AATA 2121 (23 July 2019), in which it was determined that Mr Ditchfield, who had a leg-length discrepancy, had a substantial reduction in functional capacity to mobilise because he relied on an orthotic designed to help him balance and walk.
A person’s functional capacity will be assessed against that which is to be expected of someone of a similar age. See KDYG and National Disability Insurance Agency  AATA 3411 (10 September 2019), in which the tribunal found that the help the applicant requires is not consistent with normal expectations of a person of a similar age .
Access via the early intervention requirements
Access to the NDIS via s 25 of the NDIS Act should be considered where a person is having difficulty establishing that they experience a substantial reduction in functional capacity, as required by the s 24 (NDIS Act) access criteria.
Generally, additional expert evidence will be required to demonstrate that intervention will change the likely trajectory of a person’s impairment. However, young children (under 6 years of age) who have been diagnosed with developmental delay will not need to provide evidence regarding the benefit of early intervention supports on the child’s impairment (rr 6.8–6.11 Becoming a Participant Rules).
See James and National Disability Insurance Agency  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 ’.
Streamlined access for people diagnosed with certain conditions
The NDIA has published lists of conditions in their Access to the NDIS Operational Guideline that enable a streamlined access process for people diagnosed with certain conditions.
People diagnosed with a List A condition will be accepted as meeting the disability access requirements without further assessment. People diagnosed with a List B condition will 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.