I disagree with an NDIA decision

When a decision is made that you disagree with, it's important to understand that it's ok to feel upset, angry, or distressed.

It is important to acknowledge the emotional impact this might have on you, and to think about how you can respond in a way that works for you. You can talk to a friend, family member or someone you know who might have applied to the National Disability Insurance Scheme (NDIS).

To help you respond, it can help to think about what the NDIA is saying. This can be difficult when you're feeling overwhelmed. You may want to leave it for a few days to give yourself time to think and reflect. You can return to thinking about the problem when you feel you are ready. Addressing the problem could be an opportunity for positive change.

You can also refer to the My identity and keeping myself safe section of this toolkit for help.

It’s important to remember that most decisions about eligibility are made because the NDIA believes the evidence you provided did not meet the access and eligibility criteria. This could be because it didn't:

• demonstrate your psychosocial disability is likely to be permanent
• demonstrate the impact your psychosocial disability has on your daily life
• show that you have tried all appropriate or clinically indicated treatment options for your mental health issue.

What do I do next?

The way to approach this is to look at the reasons why the NDIA has denied your application. If you find what they've said hard to understand, ask them to give you the information in a more accessible way. You can ask for help from a support organisation to make sense of the decision.

There are a few options for what to do next:

• Provide the NDIS with extra evidence to support your application.
• Speak to an organisation that can help you make an appeal.
• Gather extra evidence and request an internal review of a reviewable decision. This must be done within three months of receiving the letter telling you that your request to access the NDIS has been denied. See the 'Can I ask the NDIA to review a decision?' section on this page for more information.
• Remember, applying for the NDIS is your choice. You can decide to leave your application for now, reapply later, or see what other supports are available.

The NDIA may make a decision about your plan that you don't like. For example, you didn't get funding for something you need.

There are three different ways to appeal the decision:

You can request a ‘variation’ to your NDIS plan for the following reasons.

For more information, visit the NDIS website(opens in a new window).

The NDIA has a process for looking at the decisions they make. This section provides you with information about how they do this.

The Internal Review

An Internal Review is the way the NDIA looks at a decision they’ve made. This is called a reviewable decision. A reviewer will have the job of looking at the decision-making process and deciding whether a different decision needs to be made.

How do I request an Internal Review?

To request an Internal Review you will need to:

• contact the NDIA to tell them you want them to review a decision they made
• tell them why you think their decision is wrong
• make the request within three months of receiving the NDIA decision you don’t like
• provide the NDIA with any extra written information or evidence to support your request.

You can contact the NDIA by using the Request for a Review of a Decision form, by email or by phone. You can nominate someone to speak to the NDIA on your behalf, but you must let them know that you consent to this. This could be a family member, friend, advocate, or worker such as your support coordinator. For more information about the internal review process, visit the NDIS website(opens in a new window).

What happens after I request an Internal Review?

The NDIA must provide you with the reasons why they made their original decision. They will then get a different person to look at the original decision. They will look at the information used to make the original decision as well as any new information you have provided.

Getting the outcome of the Internal Review

You will get a letter with the result of the Internal Review. It will explain the decision the reviewer has made, and the reasons for their decision. It will either:

• Confirm the reviewable decision – which means the original decision has not changed.
• Vary the reviewable decision – which means part of the decision has been changed.
• Set aside the reviewable decision and substitute a new decision – which means overriding the original decision and making a new one.

If you don’t like the outcome of the Internal Review, see the 'Can I appeal a decision the NDIA have made?' section on this page.

You will first need to have an Internal Review. See the 'Can I ask the NDIS to review a decision?' section on this page for more information.

What if I don’t like the outcome of the Internal Review?

You can apply to the Administrative Appeals Tribunal (AAT). The AAT is an independent organisation that can review the decision made by the NDIA. This is called an External Merit Review. To do this, you must have gone through the Internal Review process. The AAT is not a court, but its decisions can be reviewed by the Federal Court of Australia.

How do I apply for an AAT External Merit Review?

You can apply:

• via the AAT website
• by filling out an Application for review of decision (individual) form. You can deliver it to an AAT registry office or send it by post, email or fax
• by writing a letter and delivering it to an AAT registry office or sending it by post, email or fax.

The AAT website lists the location and contact details for your state.

What happens after I apply for an External Review?

An AAT officer will contact you to talk about your application within three days of receiving it. If you have any questions, ask the AAT officer. You can also contact VMIAC for appeals advocacy.

The process will then follow these steps:

1. The AAT will let the NDIA know that you have put in an application.
2. The NDIA will send copies of all documents they have relevant to your application to the AAT and you. They have 28 days to do this after they are notified.
3. You will be invited to a case conference. This is an informal meeting to discuss your case and try to reach an agreement. There may be several case conferences.
4. If there is no agreement, a case plan is developed and a conciliation meeting is held to try and reach an agreement.
5. If there is no agreement at the conciliation meeting, a hearing will be held. At the hearing information and arguments will be presented. You can seek legal advice or representation for the hearing.

The AAT can review plans that have been varied or replaced by new plans even if this has happened during the period of time that you've applied to the AAT. This is to make sure that they make a decision based on your current circumstances. You may wish to gain legal advice to support you through the appeals process. To do this, see the options in the 'Other resources' section of this page.

There are a few ways you can make a complaint about the NDIS or your service providers. You can submit a complaint to the:

• NDIS
• Commonwealth Ombudsman
• NDIS Quality and Safeguards commission.

You have the right to freedom of information. This means you have the right to access information about yourself. Find out how to access your information on the NDIS website.

You have the right to make a complaint about the NDIS or services providers. The NDIS Quality and Safeguards Commission has more information about how to do this.

You have the right to make a participant information access request. This is when you ask for information about your NDIS application or NDIS plan, including the reasons for the decisions made.

You have the right to apply to the Administrative Appeals Tribunal about NDIS decisions. For more information about how to do this, visit the AAT website.