NDIS Plan Reviews
NDIS plan reviews are often a very stressful time.
There are a couple reasons why you might choose to have a plan review.
Whether your current plan is coming to an end, you have been declined for a certain support, have not been approved for as much as you requested or your circumstances have changed and your current plan is not meeting your needs.
Types of Reviews:
Automatic plan extensions
Automatic plan extensions are becoming more common these days. If you are eligible you may be able to have your plan automatically extended without the need for a plan review. This means that your current plan will continue unchanged for another 12 months. You should be contacted prior to the end of your plan to confirm your eligibility.
It's important to remember that if you are offered an automatic plan extension you don't have to comply and can still request a plan review.
Plan Changeover Review
Your Local Area Coordinator (LAC) will conduct an interview to discuss your ongoing needs, prepare the application and submit it on your behalf.
You are allowed to bring a support person to these interviews. It can be quite helpful to do this if nothing else to make notes and write down details so that you can focus on the conversation.
You can do these by phone but if you have the option of attending in person or over Zoom this is always advisable. With these sorts of discussions, putting a face to the voice can often help.
S100 review:
This type of review is internal but is handled by a different NDIA delegate than the one who made the initial decision.
How to apply:
The request must be made within 3 months of the original decision
Downloadable form that you can fill out and submit: https://www.ndis.gov.au/media/3101/download
Phone: 1800 800 110 and they can help you in submitting a request
Email: enquiries@ndis.gov.au.
By talking to your Support Coordinator or Local Area Coordinator.
In writing to:
Chief Executive Officer
National Disability Insurance Agency
GPO Box 700
Canberra
ACT 2601
Helpful information:
You need a clear explanation of why the initial decision is wrong. This form www.ndis.gov.au/participants/how-review-planning-decision is not essential, but is helpful in concisely breaking down why you want a review and is a great starting point.
Requesting a participant information access (PIA) shows the information used by the NDIA to make their decision. Seeing this information may present some information errors and give you a target for your explanation and evidence you provide. https://www.ndis.gov.au/about-us/policies/access-information/participant-information-access-request
Not all information relating to the decision can be accessed through a PIA. In some cases a freedom of information request can be lodged to get a deeper level of information and notes made. There are some drawbacks though, while the PIA is free a FOI request costs and can take significantly longer. For more straight forward review requests a PIA is often sufficient but an FOI request can be beneficial for more complex reviews.
S48 review, also known as (CoC) ;
If your plan's funding is no longer suitable due to a change in circumstances you can apply at any time for this review. It is essential that you have evidence proving;
Change in disability needs
Significant change in care/support provided by family and friends
Change in living arrangements
What you need:
A clear explanation and evidence that supports it. Evidence can include; letter from medical specialists, psychologists, psychiatrists and of your support works or suppliers.
Carer (impact) statement or statement of lived experience.
Functional capacity assessment from an OT
Cross references in any reports and support letters can also help. For example if you are requesting an increase for speech therapy a reference to this by a psychologist as well as a speech therapist can hold additional weight.
AAT Review: Administrative Appeals Tribunal
This is like the court for NDIS funding. When other reviews fail to get the result wanted this is the next option. This review is not conducted by anyone associated with the NDIA.
How to do it:
An S100 review must be completed before the AAT will hear and appeal through them.
Online within 28 days of the internal review. The completion time can be extended depending on the circumstances.
www.forms.aat.gov.au/landing.htm?formCode=app-for-review
Helpful information:
It can me a long process, possibly months before a case conference can be scheduled due to demand.
You can apply to have a advocate to assist in the process, to be there during calls etc. Possible Advocate services you can use that are NDIS funded;
People with Disabilities WA – 94207279
MIDLAS – 9250 2123
Explorability – 6361 6001
Individual Disability Advocacy Service (IDAS) – 6253 9500
KIN Advocacy (EDAC) – 1800 659 921
Uniting – 1300 663 298
You can get legal support for yourself, the NDIA is represented by external lawyers.
Legal Aid can assist with funding for legal support
There can be multiple case conferences that normally span between 3-6 hours each.
Evidence reports can use funds from your NDIS plan that typically would have been used for other therapies. An S42d can be used to get more funds, if the applicant is at risk of not being able to afford services due to using it for legal funds.
If the NDIA requests a certain piece of evidence then the applicant can apply for the ndia to assist in getting it, including paying to obtain it.
What is involved:
It begins with a case conference often over the phone. An independent individual will go through what you submitted. Then via lawyer the NDIA explains their initial choice. then there is a discussion on whether the NDIA will make the changes you desire without a hearing.
A conciliation conference may occur, it is usually via video call for 2-3 hours usually.
Then it goes to court, if you don’t already have legal representation the AAT may request it and the NDIA sometimes makes that arrangement.
Reviews can often be frustrating and sometimes daunting.
Some good final advice:
Be prepared, gather your evidence and reports.
Get good advice. talk to an Advocate, a trusted Plan Manager or Support coordinator.
It can be an emotional time. While this is perfectly understandable, patience, persistence and determination will often yield the result you need.
If you need more information, look into the links below;
