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Understanding the NDIS
What is the NDIS?

The National Disability Insurance Scheme (NDIS) is a national scheme that gives some disabled people funding to pay for supports related to their disability. These supports help you with everyday life and with reaching your goals.   

The NDIS is not the only help available. In Victoria, there are supports like the Home and Community Care program for Young People (HACC-PYP), and My Age Care, if you are 65 years or older (50 years or older, if you are Aboriginal and/or Torres Strait Islander). Other services like health, education, housing and employment services also have a role to play outside the NDIS. 

There are two sets of eligibility requirements – the general eligibility, and the disability requirements.

The general eligibility rules are:

  • you are younger than 65 when you apply
  • you live in Australia
  • you are an Australian citizen or permanent resident

The disability requirements are a bit more complicated.

In brief:

  • You have a disability attributable to one or more impairments. This means your disability and impairments are linked. 
  • You have tried all ‘appropriate treatment‘. 
  • Your impairment is likely to be permanent.
  • Your impairment means you have a substantially reduced functional capacity to do one or more domains of daily life.
    • These domains include moving around, communicating, socialising, learning, undertaking self-care, or self-management tasks.
  • Your impairment affects your ability to work, study or take part in social life.
  • You will have a need for NDIS-specific supports, due to the disability recognised by the NDIS, for your lifetime.

If you apply and meet these rules you become an NDIS participant. 

If you are thinking about applying see Applying for the NDIS below. We explain what all of that means, the access process, and how to speak up for yourself when giving evidence to the NDIA.

What if I need NDIS supports, but I’m not a citizen or permanent resident?

  • In Victoria, people aged 5 – 65 who are not citizens or permanent residents may be eligible for Victorians Ineligible for NDIS, Continuity of Support (VIN-CoS). 
  • VIN-CoS is only available if there are no other options for support.
  • All alternative funding and support options must be explored and exhausted prior to submitting a request.

The NDIS and the NDIA are related, but different.

The National Disability Insurance Scheme (NDIS) is the scheme and the supports you get.

The National Disability Insurance Agency (NDIA) is the Australian Government organisation that runs the NDIS. NDIA planners and delegates make decisions under the NDIS Act, including whether you can join and how much funding you get. They’re the people you deal with

There are a lot of NDIS-specific terms. You don’t need to memorise them, but they can be useful to know.

  • Participant: a person who has applied to the NDIS and been granted access. 
  • NDIS plan: what supports the NDIS decides to fund, and how much funding they allocate to those supports, over a period of time (usually between 12 months and 5 years). This document will also include information about you and your goals.
  • NDIS supports: the things that the NDIS will pay for in general (services, items, equipment, home modifications). A support has to be in your plan for the NDIS to fund it for you. 
  • Provider: a person or company being paid to provide NDIS supports. 
  • Choice and control: your right to decide what supports you get and how  
  • Nominee: someone you have authorised to do certain things with the NDIS on your behalf. There are two kinds of nominee:
    • correspondence nominee: they can ask for information on your behalf, and ask for information about you. They will receive the majority of contact from the NDIS (letters, emails, phone calls, notices) instead of you; they will be notified if the NDIS contacts you directly.
    • plan nominee: they can make decisions about your plan on your behalf. They are supposed to represent your interests, will and preference.
  • Delegate / Planner: the person at the NDIS who makes your plan, and is allowed to make decisions about funding and supports.
  • Local Area Coordinator (LAC): someone who works at a partner organisation (sub-contracted to the NDIS). Their role is to help you navigate the NDIS, including getting access, going through the planning and plan implementation process, and getting linked in with community support.  
  • My NDIS Contact: a designated contact person. This may be your LAC, or may be someone at the NDIA  people with more complex support needs or setting-based barriers to communication. You can read more about it here, and check who your contact is through myGov.
  • Liaison officers: people in hospitals and justice settings who are there to help you communicate with the NDIA.
  • NDIS Quality and Safeguards Commission: regulator of safety and quality of NDIS supports.

Knowing your rights is an important part of making sure your rights are upheld.

  • You have the right to dignity and respect.
  • You have the right to live free from abuse, exploitation, and violence.
  • You have the right to make your own choices.
    • If you are living under a guardianship order, you have the right to be involved in decisions (through supported decision making) that are covered by the order.

  • You have communication rights. You have the right communication in the way that works best for you and the way that you understand best.

  • You have a right to ask questions and be given explanations. This means that if the NDIA makes a decision, you have the right to know why the decision was made.

  • You have the right to ethical, safe and quality supports. NDIS workers and providers are covered by a code of conduct. The code sets out a range of things they must do, or must not do.
  • You have the right to disagree with a decision made by the NDIA. You can ask for an internal review, and sometimes an external review through the Administrative Review Tribunal (ART).

The NDIS can be complicated. It can also be difficult to work out who can help with what. 

There are a number of people, programs and organisations that can help you navigate different parts of the NDIS. The right place to start will depend on what you need help with, what supports you already have, and what stage you are at. 

Local Area Coordinators (LACs) 

Local Area Coordinators can help people understand and navigate the NDIS. This can include helping you understand the access process, connecting you with community and mainstream services, and supporting you through parts of the planning process. 

They are paid to do this by the NDIA, though they often work for partner organisations, so many advocacy organisations will ask that you start here.

Support coordinators 

If you have support coordination funded in your NDIS plan, your support coordinator can help you understand and use your plan, connect with appropriate services and supports, and navigate the NDIS.

Depending on how much funding you have and your situation, that navigation can include preparing for a plan reassessment, understanding NDIS processes, or addressing issues with service providers. 

Not everyone has support coordination in their plan. If you do, however, your support coordinator is usually a good first point of contact if you think an issue might be within their scope.

Case managers, social workers and similar supports 

Some people already work with a case manager, social worker or another professional whose role includes helping them navigate services and systems. 

These roles vary considerably. Some programs provide broad support, while others have specific purposes or eligibility requirements. 

If you already work with a case manager, social worker or similar professional, it may be worth asking whether they can help with your NDIS issue. They may be able to help you gather information, communicate with services, connect with other supports or work out where you need to go next. 

NDIS access support programs 

There are also programs that specifically help people apply for and access the NDIS. 

These programs may work with particular groups of people or types of disability. For example, the Mental Health NDIS Access Project provides support to eligible people with psychosocial disability who need help navigating the NDIS access process. 

If your main issue is applying for the NDIS, an access support program may be more appropriate than ongoing individual advocacy. 

Disability advocates (that’s us!)

A disability advocate can help you understand and exercise your rights and have your voice heard. 

Advocacy is different from case management, support coordination or general NDIS navigation. An advocate does not take over management of your NDIS supports or become responsible for managing your case. 

Depending on the advocacy organisation’s scope, an advocate may be able to help with a specific issue or barrier you are experiencing with the NDIS. This might include helping you understand your options, prepare to communicate with the NDIA, make a complaint, or advocate for yourself. 

Different advocacy organisations have different eligibility requirements, service areas and scopes, so it is important to check what an organisation can assist with before making a referral or enquiry. 

NDIS Appeals advocacy 

If you disagree with an NDIS decision and have progressed to the Administrative Review Tribunal (ART), there are advocacy services specifically funded to support people with NDIS appeals. 

ART advocacy is a specialised service and is different from general disability advocacy. Not every disability advocacy organisation provides support with ART matters. 

If you are looking for advocacy support for an external NDIS review, you can find a full list of advocacy organisations funded to provide ART support here. You can filter the list by state.

Reach out as soon as possible after you have lodged your review, as there can be a wait.

What if I need NDIS supports, but I’m not a citizen or permanent resident?

In Victoria, people aged 5 – 65 who are not citizens or permanent residents may be eligible for Victorians Ineligible for NDIS, Continuity of Support (VIN-CoS). 

  • VIN-CoS is only available if there are no other options for support.
  • All alternative funding and support options must be explored and exhausted prior to submitting a request.

The first step in applying is confirming you meet the general eligibility requirements:

  • You are younger than 65 when you apply.
  • You live in Australia.
  • You are an Australian citizen or permanent resident.

The disability eligibility is a bit more complicated.

You need to be able to provide evidence that:

  • You have a disability attributable to one or more impairments. This means your disability and impairments are linked. 
  • Your impairment is likely to be permanent. 
  • Your impairment means you have a substantially reduced functional capacity  in one or more domains* of daily life.
    • These domains include moving around, communicating, socialising, learning, undertaking self-care, or self-management tasks.
    • The NDIA refers to ‘domains’ as ‘activities’ – see our glossary for more information.
    • With the new legislative changes, functional capacity now must be assessed ‘considering each [domain] as a whole’, using the NDIS definitions of the domains. 
      • This means that your documentation must speak to the whole domain or domains that you experience impairments if your documentation suggests that you are only partially affected in one or more domains, you are unlikely to be successful. 
      • Some professional bodies like OTSI have templates for OTs and other clinicians – these are very worth using if you have ‘invisible’ disabilities like Autism or ME/CFS, so ask your clinicians about it.  
  • Your impairment affects your ability to work, study or take part in social life. 
  • You will have a need for NDIS-specific supports, due to the disability recognised by the NDIS, for your lifetime. 
    • This point covers two things: 
      • You will be disabled and need support for your lifetime. 
      • The NDIS is the most appropriate support; that is, that other existing services are not adequate options for you. 
      • You must prove both. 
  • You must have tried all ‘appropriate treatment‘.
    • This is defined as treatment which is: 
      • Evidence-based 
      • Can be reliably expected to ‘materially improve, reverse or alleviate‘ the impairment 
      • Is publicly available in Australia 
    • In practice, it can be hard to work out what treatments might be expected to be on this list. You can review Freedom Of Information disclosure logs from the NDIS to see if any relevant information is available regarding what they would consider to be standard treatments for a particular disability.
      • If none are available, you can FOI the NDIS yourself if you would like that information. 
    • If there is something that might fall into that list that you couldn’t try for medical reasons, they will accept that, but you must explain it.  
    • If there is something that might fall into that list that you couldn’t try for financial or geographical reasons (e.g. living too far away), this will not be accepted. 

For more comprehensive information, check out Queensland Advocacy for Inclusion’s NDIS access FAQ.

For more about what evidence you will need to provide, and what your reports should look like – continue to the next section.

To apply, you will need to fill out an access request form. 

You will need to provide evidence to support this.

  • Recent reports, written within the last 6 months, are considered the best quality evidence by the NDIS. Evidence must be within 2 years to be considered. 

You need to provide both medical evidence and functional evidence to support this. You can also provide lived experience statements. You can read more about all three of those in the sections below.

Think of your evidence as different pieces of the same picture:

  • Medical evidence helps explain your disability, impairment, treatment and permanency. 
  • Functional evidence helps explain how your impairment affects your ability to carry out everyday activities. 
  • Your own evidence helps explain what living with your disability actually looks like day to day. 

If you are applying under two disabilities (e.g. one primary, one secondary) you will need to provide this evidence separately for each disability. It is important that all of your documentation corresponds with each other.

  • Harmonious documentation makes for a strong application.
  • Contradictory documentation weakens an application.

More evidence is not necessarily better evidence. Before sending in all the reports you have, ask: what does the NDIA need this evidence to show? You want to make it as easy as possible for the person assessing your application to see that you meet all the criteria. 

Think of the access requirements as questions that your evidence needs to answer: 

  • If the NDIA needs evidence that a disability is permanent, make sure there is evidence that clearly addresses permanency. 
  • If the issue is about how the disability affects your life, make sure the evidence clearly and comprehensively describes the functional impact of your disability. 
  • If the NDIA is asking about treatment, make sure the evidence addresses treatment and its outcomes. 
  • A large collection of medical records may show that you have been receiving treatment for years – but not actually clearly answer the question the NDIA needs answered. 

Organising your evidence around what the NDIA needs to know can make it easier for you to spot gaps and make your case. 

You want to make it as easy as possible for the person assessing your application to see that you meet all the criteria. 

You can use a document like this table of evidence from Queensland Advocacy for Inclusion as a cover page to show the evidence you are supplying as part of your access request.

Queensland Advocacy for Inclusion has a guide to documents needed for access, and helpful information about what those reports might look like. 

You can also check out People with Disability Western Australia’s NDIS Access and Request Toolkit, and VALID’s guide to report writing for the NDIS.

Medical Evidence
What is medical evidence?

Medical evidence helps establish:

  • what your disability is
  • what impairments are linked to it
  • its history
  • the treatment you have received
  • whether the impairment is likely to be permanent

This evidence might come from your: 

  • GP 
  • medical specialist (e.g. rheumatologist)
  • psychiatrist 
  • psychologist 
  • other treating health professionals. 

It might include:

  • existing medical reports
  • specialist letters
  • assessments
  • treatment records
  • a letter or report prepared specifically for your NDIS application 

A diagnosis by itself does not provide all of the information the NDIA needs. Your medical evidence needs to: 

  • identify disability / diagnosis 
  • identify the impairment/s that you experience as a result of your disability
  • evidence how long you have experienced the disability and impairment/s
  • evidence the permanency of the impairment/s 
  • evidence that you have tried all ‘appropriate treatment‘.
    • This is defined as treatment which is: 
      • Evidence-based 
      • Can be reliably expected to ‘materially improve, reverse or alleviate‘ the impairment 
      • Is publicly available in Australia 
    • In practice, it can be hard to work out what treatments might be expected to be on this list. You can review Freedom Of Information disclosure logs from the NDIS to see if any relevant information is available regarding what they would consider to be standard treatments for a particular disability.
      • If none are available, you can FOI the NDIS yourself if you would like that information. 
    • If there is something that might fall into that list that you couldn’t try for medical reasons, they will accept that, but you must explain it.  
    • If there is something that might fall into that list that you couldn’t try for financial or geographical reasons (e.g. living too far away), this will not be accepted. 
  • outline why any existing alternative supports are unsuitable or ineffective
  • outline why you have a need for NDIS-specific supports, due to the disability and impairment/s recognised by the NDIS
    • evidence that you will need these supports for your lifetime. 

Very few people are trained in writing reports for the NDIS (or even navigating systems like the NDIS at all). Your doctor may know your medical history extremely well, but not so much about the information the NDIA needs to make an access decision. 

When asking someone to provide evidence, take this guide, and the linked report writing guides with you. Explain that the evidence is for an NDIS access request, and that these guides lay out what the NDIA will be looking for.

Rather than simply repeating your medical history, useful evidence connects the medical information to the relevant NDIS access requirements. 

What is functional evidence?

The medical evidence tells the NDIA what your diagnosis and impairment/s are.

Functional evidence explains what your impairment means in your everyday life. Two people with the same diagnosis can experience very different levels of functional impact. This is why evidence about your individual experience is important.

Functional evidence usually comes from allied health clinicians or other professionals who can complete assessments to understand how your disability affects your everyday activities. Depending on your disability, this might include: 

  • occupational therapist 
  • physiotherapist 
  • psychologist 
  • speech pathologist 
  • social worker 
  • other appropriately qualified professional. 

Different professionals may be able to provide evidence about different areas of your functioning. 

Part D: Existing Assessments (page 17) of the Access Request Form  lists some of the assessments that someone may choose to complete for their application – this can be useful to look at if you’re not sure what you need.

You do not necessarily need every type of assessment. Before paying for additional reports, look at what evidence you already have and identify whether there are important gaps. 

The NDIS is interested in a substantially reduced functional capacity  in one or more domains* of daily life.

Those domains are:

  • mobility 
  • communication 
  • social interaction 
  • learning 
  • self-care 
  • self-management

Functional evidence needs to:

  • describe the impact of your impairment/s on your functional capacity: 
  • map to at least one of the six domains that the NDIS considers (communication, social interaction, learning, mobility, self-care and self-management)
    • speaking to the domain comprehensively as a whole.
    • If your documentation suggests that you are only partially affected in one or more domains, you are unlikely to be successful. 
      • Some professional bodies like OTSI have templates for OTs and other clinicians – these are very worth using if you have ‘invisible’ disabilities like Autism or ME/CFS, so ask your clinicians about it.
  • outline why you have a need for NDIS-specific supports, due to the disability and impairment/s recognised by the NDIS
    • evidence that you will need these supports for your lifetime. 
  • outline why any existing alternative supports are unsuitable or ineffective

Being physically capable of doing something once does not necessarily tell the whole story about your functional capacity. 

For example, you may technically be able to prepare a meal but need prompting to start, assistance to safely use equipment, breaks throughout the task, or significant time to recover afterwards (and/or be unable to do other tasks). Those details help explain the actual impact of your impairment.

Functional evidence can describe what happens when you actually try to complete everyday activities.

Think about a normal day or week and ask yourself: 

  • What activities are difficult or impossible without assistance? 
  • What support do I currently receive? 
  • Who provides that support? 
  • What happens when that support is unavailable? 
  • What activities take me much longer than other people? 
  • What do I need prompting, supervision or assistance to do? 
  • Are there activities I avoid because of my disability? 
  • Are there things that I do differently to avoid negative impact from my disability?
  • What happens if I push myself to complete an activity? 
  • Does completing one activity affect what I can do afterwards? 
  • Does my capacity change from day to day? 
  • What does a bad day look like compared with a good day? 
  • Do I ever need additional support to complete everyday activities? This could include:
    • Reminders
    • Prompting
    • Supervision
    • Changes or modifications
    • Equipment
    • Help or support

You can refer to this functional impact guide to get you thinking, or this example of functional impacts for psychosocial disability from Aftercare.

You know yourself best.

You live with your disability every day. Information from you can help explain what your disability actually looks like outside a doctor’s office or assessment.  Consider submitting a lived experience statement.

Think about a normal day or week and ask yourself: 

  • What activities are difficult or impossible without assistance? 
  • What support do I currently receive? 
  • Who provides that support? 
  • What happens when that support is unavailable? 
  • What activities take me much longer than other people? 
  • What do I need prompting, supervision or assistance to do? 
  • Are there activities I avoid because of my disability? 
  • Are there things that I do differently to avoid negative impact from my disability?
  • What happens if I push myself to complete an activity? 
  • Does completing one activity affect what I can do afterwards? 
  • Does my capacity change from day to day? 
  • What does a bad day look like compared with a good day? 

You can refer to this functional impact guide to get you thinking, or this example of functional impacts for psychosocial disability from Aftercare.

Try to be specific. 

It can be tempting to write about what you can do on a good day, or with a lot of support, or when you push yourself further than you should. That may not give the NDIA an accurate picture of your everyday support needs.

Instead of: 

“I can shower independently.” 

you might need to explain: 

“I can physically shower without another person washing me, but I need someone to remind me to shower and I use a shower chair because I cannot safely stand for the whole shower. Afterwards I usually need to lie down for around 30 minutes before I can do another activity.” 

The second description provides much more information about what completing the activity actually requires.

This process can be difficult – it can bring up feelings around grief, shame and internalised (and not so internalised ableism). Many people have been not-coping without support for a long time, and find it hard to sit with writing these documents. Get support if you need to.

People who know you well or regularly provide you with support can also provide a statement.

This could include family members, carers, support workers or other people who have direct knowledge of the assistance you need. 

Their evidence can provide practical examples of the support you receive, what happens without that support, and how your disability affects your everyday life.

This functional impact guide may be useful, or this example of functional impacts for psychosocial disability from Aftercare.

You do not need to prove the same thing repeatedly. 

Think of your evidence as different pieces of the same picture: 

Medical evidence helps explain your disability, impairment, treatment and permanency. 

Functional evidence helps explain how your impairment affects your ability to carry out everyday activities. 

Your own evidence helps explain what living with your disability actually looks like day to day. 

Together, these can give the NDIA a clearer picture of your individual circumstances. 

Before getting new reports or assessments, consider: 

  • What does the NDIA need to decide? 
  • What evidence do I already have? 
  • What does that evidence already establish? 
  • Is there anything important that is not explained? 
  • Who is the best person to provide that missing information? 

The goal is not necessarily to collect more evidence. It is to provide the right evidence for the issue the NDIA needs to decide.

This does not mean that you are being refused – but it does mean that the NDIA believes that information is missing from your access request. 

Read the request from the NDIA carefully, and try to identify what information they are looking for. 

Ask yourself: 

  • What does the NDIA need to decide? 
  • Which access requirement does this information relate to? 
  • Do I already have evidence that covers this? 
    • If yes, and I’ve provided it, why does the NDIA think it’s missing?
      • Is my evidence insufficient, or has something else happened?
    • If not, who is the best person to provide the missing information? 

If you do not understand what the NDIA is asking for, or you want to be sure that you are reading the letter the way they mean it, ask them to explain it. 

Keep copies of all of your documentation and everything you send to the NDIA, and record when and how it was sent.  

If you call the NDIA (1800 800 110), or they call you, record the time and date of the call, and record what is said in the conversation. 

If the NDIA decides that you are not eligible for the NDIS, they will send you a written decision explaining why. 

Read the reasons carefully. Understanding why you were refused will help you decide what to do next. 

  • If you don’t understand what the letter means, you can call (1800 800 110) and ask them to explain it to you. Record the time and date of the call, and record what is said in the conversation. 

If you disagree with the decision, you can ask for it to be reviewed. Victoria Legal Aid have a great breakdown of your rights and the review process here. 

Your first step is to ask for an internal review. You generally have 3 months from the date of notification (the day you received the decision) to do this. 

When requesting a review, explain clearly: 

  • what decision you disagree with 
  • why you think it should be different 
  • what information or evidence supports your position 
  • any additional evidence you want considered. 

You can request an internal review using this form, or by calling the NDIA (1800 800 110). 

  • If you call, make sure you note down the date and time of the call, and get a receipt number. 

If the internal review upholds the refusal, and you still disagree with the decision, you can ask for an external review through the Administrative Review Tribunal (ART). 

  • You have 28 days from the date of notification to ask for an external review.  
  • You need to lodge the request directly with the ART. 
  • You can call the ART (1800 228 333) or lodge an application online on the ART’s website, using the ‘Apply Now’ button. 

ART is a court, but it is free and you can represent yourself.  

You might still want some support if you are going to ART though, so after you have asked for an external review, you can contact an organisation funded to do ART advocacy and ask for their help. There is a list of those organisations here – you can filter the list by state. 

  • It is best to do this as early as possible after lodging the review, as there is often a long wait. 

Generally speaking, double check everything yourself from point of lodgement onwards; don’t assume that because the NDIA has something, that the tribunal will have it – provide copies of everything yourself, directly, to the tribunal. 

If you do anticipate incurring costs in preparing for the review, and you can’t afford it, you may be able to get some financial assistance through the Attorney-General’s department. Do not rely on this – it is only available in particular circumstances, and they generally will not reimburse costs from prior to your application.

Local Area Coordinator (LAC) 

The Mental Health NDIS Access Project 

  • For people with psychosocial disability 

NDIS Allied Health Assessment 

  • For people in Knox, Maroondah, Yarra Ranges LGAs – help applying or preparing for an unscheduled plan review 

Your local community health service  

  • Community health services usually have occupational therapy, and sometimes social work services; if you are eligible for their services, they may be useful in helping you through these processes. 

Other disabled people 

  • If you search ‘[disability type / disability name /condition] and NDIS’ on Facebook, you might be able to find a group dedicated to sharing information about the NDIS specifically in the context of your disability. 
  • As a general rule, don’t share personal or identifiable information online and consider participating anonymously in groups if you need advice. 

Your NDIS plan sets out information about you, your goals, your NDIS supports and your funding. Understanding your plan can help you use your funding well and advocate for changes when your supports are not meeting your needs. 

Preparing for a planning or reassessment meeting

Before your meeting think about: 

  • What support you need day to day 
  • What is currently working 
  • What isn’t working 
  • Whether your situation has changed 
  • What supports you want to ask for and why 
  • What would happen without them  

Gather any evidence before the meeting – reports from doctors, therapists or support workers for example.   

You can bring someone with you for support. You can also ask questions or ask the person running the meeting to stop, slow down, repeat or explain anything you don’t understand. 

More information: 

NDIS How to prepare for your plan meeting

NDIS How to prepare for a plan reassessment 

Your NDIS plan includes information about your circumstances, goals, supports, funding and how that funding will be managed. 

Some funding is flexible, while some is very specific and can only be used for the support described in your plan. 

Newer NDIS plans may release funding in stages called “funding periods”.  Funding periods do not change your total funding, but they can affect when you can access it. 

If anything about your plan or funding is unclear, ask. Understanding what has actually been funded is an important part of advocating for yourself. 

More information: 

NDIS: What is an NDIS plan?

NDIS: Understanding your NDIS funding

The NDIA uses “reasonable and necessary” rules to decide what it will fund. Broadly, a support needs to relate to your disability, help you reach your goals, be good value and likely to work well. The NDIA also looks at how it fits alongside family, community and other everyday supports. 

Rather than trying to remember all of the rules, you can use the NDIA’s current guidance when preparing a request. 

More information: 

NDIS: What is reasonable and necessary

Be specific about what you are asking for.  

Explain: 

  • what support you need 
  • how much or how often you need it 
  • what disability-related need the support addresses 
  • how it will help you in your everyday life 
  • what you currently do without it 
  • what happens when the support isn’t available 

 

For example, simply saying “I need more support worker hours” doesn’t explain the need. 

Its much clearer to explain what tasks you need help with, how often why you can’t do them alone and what happens without help.  

You don’t need to use NDIS jargon. Clear, plain descriptions of your actual needs work better than trying to sound official.  

Evidence should help explain why you need the support, not simply confirm your diagnosis. 

Depending on what you are asking for, useful evidence might explain: 

  • your functional capacity / day to day abilities 
  • what help you need 
  • how often you need it 
  • what has already been tried and whether it worked 
  • why this support is the right one 
  • what is likely to happen without it 

Think about who is best placed to provide the evidence you need. Different professionals may be able to provide evidence about different aspects of your support needs. 

Before obtaining a new report, consider what question you need the evidence to answer and whether you already have something that answers it. 

Your circumstances and support needs can change. 

For example, your abilities, living situation, work, study or the support you get from family and friends might change. 

You don’t have to wait until your plan ends to tell the NDIA about a big change. Where possible, keep evidence of important changes, especially ones that affect your support needs.  

There are two main ways the NDIA can change a plan. 

  • A plan variation changes part of your existing plan without replacing the whole plan. This is good for smaller changes. 
  • A plan reassessment looks again at  your support needs and may result in a new plan. This may be appropriate where there has been a significant change and your existing plan no longer meets your needs. 

If you are asking for a plan reassessment, explain what has changed, why you need a new look at your plan and back it up with evidence.  

More information: 

NDIS: Guide to changing your plan

First, identify what the actual problem is. 

  • Is a support you need missing from your plan? 
  • Is there not enough funding for something? 
  • Have your circumstances or support needs changed? 
  • Is the problem about how your funding can be used? 
  • Or is the problem with a provider, not your NDIS plan? 

Once you know what the problem is, you can work out the appropriate next step. 

If your circumstances have significantly changed, you may need to ask for your plan to be changed. 

If you disagree with a decision the NDIA made when approving your plan, you may have review rights. 

If the funding is there but you are having difficulty finding or receiving the support, changing the plan may not necessarily solve the problem. 

See also:

NDIS:Changing an NDIS plan 

NDIS: Guide to decision reviews 

 

When advocating for a support, try to answer three questions: 

  1. What am I asking for? Be specific about the support you need, including how much or how often. 
  2. Why do I need it? Explain the disability-related need the support addresses and use evidence where appropriate. 
  3. What happens without it? Explain the real impact if the support isn’t provided – less independence, difficulty with daily tasks, more reliance on family and other informal supports, less ability to work or be part of your community, or risks to your safety.  

You are not trying to make things sound as bad as possible, just given an accurate, clear picture.  

 

If you disagree with an NDIA decision, you may be able to ask for the decision to be reviewed. First make sure you understand what was decided, why and what you want changed.  

Understanding the Decision

Start by reading the decision carefully. 

Most NDIA decisions can be reviewed.  If you are not sure if yours can, ask the NDIA or seek advocacy or legal advice. 

More information: 

NDIS What is a decision review?

NDIS Appeals program 

This is the first step. A different NDIA staff member, not the original decision maker, reviews your case, looking at the facts and the relevant law.  

When requesting an internal review, explain: 

  • what decision you want reviewed 
  • what outcome you want instead 
  • why you think the decision should be different 
  • what existing information you want looked at again 
  • Whether you are providing new evidence 

You can request an internal review using the NDIA’s review form or through the other methods provided by the NDIA. 

More information: 

NDIS: How to request a review of a decision

Time limits are important. 

  • You generally have 3 months from the day you receive the original NDIA decision to request an internal review. 
  • If you disagree with the internal review decision, you generally have 28 days to apply to the Administrative Review Tribunal for an external review. 

Don’t wait until you have gathered every possible piece of evidence before checking your deadline. 

If you think you may be outside a time limit, seek advice about your options rather than assuming there is nothing you can do. 

The evidence you need will depend on why the NDIA made the decision and what you are asking to change. 

For example, if the NDIA decided that a particular support wasn’t appropriate, evidence about an unrelated part of your disability may not help address that decision. 

Useful evidence might explain: 

  • your functional capacity or day to day abilities 
  • the disability-related need the support addresses 
  • Why this particular support is needed 
  • how much or how often you need it 
  • what alternatives you have tried 
  • why another option doesn’t meet your needs 
  • what happens without the support 

 

You may already have useful evidence. Before paying for another assessment or report, look at the reasons given for the decision and ask what your evidence actually needs to show. 

Break the decision into parts you agree with and parts you don’t.  

For each part you disagree with, identify: 

  • What did the NDIA decide? 
  • Why do I think that decision is wrong? 
  • What decision do I want instead? 
  • What evidence supports what I’m saying? 

 

This can help you organise your review request instead of overwhelming it with unrelated information.  

You can apply to the Administrative Review Tribunal (ART), an independent body, for an external review, generally within 28 days of the internal review decision.  

The ART process is more formal than an internal review. You can still represent yourself, but advocacy or legal assistance can be useful. You generally can’tgo straight to ART without doing an internal review first.  

More information: 

Administrative Review Tribunal NDIS reviews

Victoria Legal Aid Your review rights and the NDIS

You can go through a review on your own, but you don’t have to. Consider getting help if:  

  • you don’t understand the decision or the reasons 
  • you aren’t sure whether the decision can be reviewed 
  • you are having difficulty identifying what evidence you need 
  • you need support communicating with the NDIA 
  • there are multiple or complicated issues 
  • you have received an internal review decision and are considering going to the ART 
  • you need legal advice about how the NDIS legislation applies to your situation. 

 

Disability advocacy and legal advice are different. An advocate can support you to understand the process and speak for yourself. A lawyer gives legal advice and can represent you.   

If you have completed an NDIA internal review and want to go to the ART,  the government’s NDIS Appeals Program offers free, specialist advocacy. This can help you understand the ART process, prepare documents, build your self-advocacy skills and attend hearings.  

Legal assistance may also be available through Legal Aid. 

More information: 

Department of Social Services NDIS Appeals Program 

Victoria Legal Aid NDIS review rights 

Administrative Review Tribunal NDIS 

You don’t need to prove everything about your disability again or argue with everything the NDIA has said. 

Start with three questions: 

  • What decision do I disagree with? 
  • Why do I think it should be different? 
  • What do I want the NDIA to decide instead? 

 

Then look at your evidence. Your strongest evidence usually addresses the issue being reviewed. 

You don’t have to disagree with the entire decision. You might agree with most of your plan but disagree with one part of it. Being clear about exactly what you are challenging makes your review request stronger.  

Important NDIS decisions should come to you in writing. Keep a copy of the decision and note the date you received it. This is important because review deadlines usually start from that date.  

If you don’t understand why a decision was made, ask the NDIA to explain it. 

Understanding the reasons can help you identify what you need to address when asking for a review. 

NDIS legislation determines which NDIA decisions can be reviewed. 

Common examples include decisions about: 

  •  whether you are eligible for the NDIS 
  • the supports funded in your plan 
  • not doing a plan reassessment 
  • not doing a plan variation 
  • varying your plan 
  • some nominee and child representative arrangements 

Working out what kind of problem you have helps you work out what to do next. 

A problem with an NDIA decision, a complaint about how the NDIA has treated you and a problem with an NDIS provider have different pathways. 

Is the problem with the NDIA, a decision or a provider?
  • Do I think an NDIA decision is wrong? This may be a review issue. (Eg. Access decisions, plan supports) 
  • Am I unhappy with the way the NDIA handled something? This may be a complaint. It could be about communication, delays, service, staff conduct or how something was handled. You can complain directly to the NDIA. 
  • Is my concern about an NDIS provider or worker? You can complain directly to your provider if you are comfortable doing so. You can also report concerns about the quality or safety of the NDIS funded supports and services to the NDIS Quality and Safeguards Commission. You can make complaints about workers to the Victorian Disability Workers Commission (VDWC).  

More information: 

NDIS – Feedback and complaints 

NDIS Quality and Safeguards Commission – Report an issue or make a complaint 

VDWC 

If you think an NDIA decision is wrong and want the decision changed, you may need to request a review.If you are unhappy with the service you received, a delay, communication, staff conduct or how something was handled, you may want to make a complaint. 

Sometimes both may apply – you can challenge a decision and complain about how you were treated, they are separate processes. A complaint doesn’treplace a review request. If there is a review deadline, don’t miss it while you are pursuing a complaint.  

You have the right to raise concerns about the quality and safety of the NDIS supports and services you receive. 

If you feel comfortable, you can raise the issue directly with your provider. Providers must have processes for managing complaints and cannot punish you for raising concerns. 

You can also contact the NDIS Quality and Safeguards Commission about concerns involving NDIS providers or workers. 

This can include concerns about: 

  • quality or safety of supports 
  • how you have been treated 
  • provider or worker conduct 
  • your rights not being respected 
  • neglect or harm 
  • other concerns about NDIS funded supports or services. 

 

NDIS Quality and Safeguards Commission – Make a complaint 

VDWC 

Complaints about the NDIA 

When complaining to the NDIA, explain: 

  • what happened 
  • when it happened 
  • who was involved, if known 
  • what you have already done to try to resolve it 
  • how it has has affected you 
  • what you would like to happen now. 

Keep a copy of your complaint and your complaint reference number. 

Commonwealth Ombudsman 

If you have complained to the NDIA and are not satisfied with its response, you may be able to complain to the Commonwealth Ombudsman. This is an independent body that looks at how the NDIA runs. They generally expect you to try and resolve it with the NDIA first. They don’t handle complaints about providers directly – those go to the NDIS Quality and Safeguards Commission.  

Commonwealth Ombudsman – National Disability Insurance Scheme 

Some problems cannot wait for an ordinary complaint process. 

  • In immediate danger or emergency contact emergency services. 
  • If you are concerned about abuse, neglect, exploitation, unsafe supports or serious risks involving an NDIS provider or worker, you can contact the NDIS Quality and Safeguards Commission. 
  • If your circumstances have changed urgently and your current NDIS plan no longer meets your disability support needs, contact the NDIA and explain what has changed and why the situation is urgent. 

Keep records of urgent issues and, where possible, evidence of what has changed and the risks you are experiencing. 

You can advocate for yourself at any stage of the NDIS process. 

This might mean: 

  • asking questions 
  • requesting information 
  • explaining what you need 
  • providing evidence 
  • asking for reasons for a decision 
  • making a complaint 
  • requesting a review 
  • telling the NDIA when something isn’t working. 

 

Self-advocacy doesn’t mean you have to manage everything by yourself. You can have someone support you while staying in control of your decisions.  

An advocate may be able to help if you are having difficulty understanding a process, communicating what you need, identifying your options or having your rights respected. 

An advocate may help you understand information, prepare for meetings, communicate your views, make a complaint or understand your options when you disagree with a decision. 

Disability Rights and Culture provides independent disability advocacy. What assistance we can provide will depend on the issue, our service scope and capacity. If we can’t help we will point you to other services.  

Consider legal advice if you’re heading to the Administrative Review Tribunal, the legal issues are complicated, you need advice on your legal rights, or you need representation. An advocate can support you, but isn’t a substitute for a lawyer when legal advice is needed. 

Disability Rights and Culture – disability advocacy 

Disability Advocacy Finder – find another independent disability advocacy service 

NDIS Appeals Program – specialist advocacy for eligible people appealing NDIS decisions to the ART 

Victoria Legal Aid – legal information, advice and assistance 

Community Legal Centres – independent community legal assistance 

NDIS Quality and Safeguards Commission – concerns about NDIS providers and workers 

Commonwealth Ombudsman – unresolved complaints about the NDIA or NDIS Commission 

Administrative Review Tribunal – external review of eligible NDIS decisions 

Victorian Disability Workers Commission