austlii:cth/ARTA/2025/2054
General information, not legal advice.
ARTA
2025-10-03
Original judgment source is linked above.
Grac and National Disability Insurance Agency (NDIS) [2025] ARTA 2054 (3 October 2025)
Respondent: National Disability Insurance Agency
Pursuant to section 114 of the Administrative Review Tribunal Act 2024, the following alteration is made to the decision in this application issued on 3 October 2025:
Respondent: National Disability Insurance Agency
Decision: The Tribunal sets aside the decision under review and in substitution decides Mr Grac satisfies the 'access criteria' for the purposes of s 20(1)(a) of the National Disability Insurance Scheme Act 2013.
NATIONAL DISABILITY INSURANCE SCHEME - application for access - access criteria - disability requirements - disability and psychosocial disability attributable to impairments - nature of impairments - no known remedial treatment - impairment likely permanent - meaning of 'substantially reduced functional capacity' - functional capacity substantially reduced in communication, social interaction, learning and self-management - capacity for social and economic participation affected - likely to require support under NDIS for life - decision set aside and substituted
National Disability Insurance Scheme (Becoming a Participant) Rules 2016
DQKZ and National Disability Insurance Agency [2024] AATA 2276
Foster and National Disability Insurance Agency [2025] ARTA 718
HPSC and National Disability Insurance Agency [2021] AATA 727
JLZT and National Disability Insurance Agency [2022] AATA 541
Madelaine and National Disability Insurance Agency [2020] AATA 4025
Mulligan v National Disability Insurance Agency [2015] FCA 544
National Disability Insurance Agency v Davis [2022] FCA 1002
National Disability Insurance Agency v Foster [2023] FCAFC 11
National Disability Insurance Agency v Jones [2025] FCA 877
Palmanova Pty Ltd v Commonwealth of Australia [2025] HCA 35
Sutherland and National Disability Insurance Agency [2024] AATA 411
World Health Organisation International Classification of Functioning Disability and Health (2011), Geneva
Applying to the NDIS' operational guidelines (Access Guidelines)
[Mr Grac] has a complex history including schizoaffective psychosis, bipolar disorder, post-traumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD), learning disability, borderline intellectual functioning, and substance abuse disorder.[3] > > [Mr Grac] has experienced ongoing challenges with his cognition, day-to-day functioning, mental and physical health. He reported difficulties with attention, memory and emotion regulation. Specifically, he described getting easily confused, difficulty focusing and completing tasks, and that he can forget information if he has not written it down. He has trouble controlling his emotions and can become easily aggressive and agitated. [Mr Grac] is socially isolated reporting that he has developed trust issues with others. [Mr Grac] has difficulty access supports for his mental health and feels his difficulties have become worse over time.[4] > > [Mr Grac's] overall intellectual abilities on current testing placed him in the Low-Average range... significant deficits were apparent in his ability to learn and recall lengthy verbal information that was presented only once, basic word reading skills, and the majority of areas of executive function including switching, cognitive flexibility, response inhibition, planning and organisation. > > While [Mr Grac] does not have an intellectual disability, he does have significant executive function deficits indicating frontal lobe dysfunction. This profile is consistent with his complex history of chronic psychiatric disorders (including anxiety, bipolar, schizoaffective disorder, PTSD and ADHD), and substance abuse (including ice and cannabis). However, it may also reflect the impact of his multiple head traumas and seizures. Neurological review and MRI scan may assist in identifying whether there may be an organic brain injury. In addition [Mr Grac] has specific learning disabilities resulting in his low level of literacy, numeracy and educational attainment. His chronic psychosocial and learning disabilities in [sic] lead to substantially reduced functional capacity to undertake everyday activities in almost all domains. > > ... his chronic disabilities significantly impact on his everyday functioning (global adaptive functioning composite rated in the 3rd percentile).[5] > > [Original emphasis].
All available treatment have been tried with [Mr Grac] and he is currently functioning at his best. No further treatment options are available.[9]
See Section 7 for details of various community-based supports and services that may be available to meet the applicant's needs
Recommendations for each domain have been considered in the context of maximising the applicant's safety and independence. The emphasis of supports is to maximise applicant task participation in activities of daily living. Support worker assistance has only been recommended in instances where independence is not likely to be achieved due to the effects of the applicant's medical conditions.
Not applicable. Mr Grac is independent in the domain of communication and no formal support or interventions are required.
In order to further improve and maximise Mr Grac's functional capacity in the domain of social interaction, I support:
Not applicable. Mr Grac is independent in the domain of learning for day-to- day responsibilities and no formal support or interventions are required.
Not applicable. Mr Grac is independent in the domain of mobility and no formal support or interventions are required.
Not applicable. Mr Grac is independent in the domain of self-care and no formal support or interventions are required.
In order to further improve and maximise Mr Grac's functional capacity in the domain of self-management, I support:
The medical evidence indicates the applicant may benefit from access to the following medical treatment and therapeutic interventions:
I defer to medical opinion to confirm recommended treatment for the applicant and the impact such treatment may have on their functional capacity in the future.
13. He has not seen a neurologist which is very unlikely [sic] to change the diagnosis and would not change the treatment possibilities > > 14. I do not believe he has seen a psychiatrist recently. I believe he may have in the past but we have not been able to assess any of that infermation [sic]. I have previous referreed to Dr Ian Hayes however [sic] because [sic] of [Mr Grac's] severe impairments as above he did not have the ability or the social support to organise and engage in the appointment. > > 15. I am not aware of any other treatments which would be likely to cure of [sic] substantially relieve [Mr Grac's] impairments - I would class them as severe and permanent.[16]
4. I do not know whether [Mr Grac] is currently compliant with his medication regime as I have not seen him since 2022. I do believe though, that his severe executive function deficits would likely impact on his ability to maintain a good routine and ability to comply with a consistent medication regime... > > 5. ... If he were to engage in recommended treatments it would not 'cure or substantially relieve' his impairments. They would help to manage symptoms and hopefully improve his quality of life and social/community engagement.[17]
(1) A person meets the disability requirements if: > > (a) the person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or the person has one or more impairments to which a psychosocial disability is attributable; and > > (b) the impairment or impairments are, or are likely to be, permanent; and > > (c) the impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities: > > (i) communication; > > (ii) social interaction; > > (iii) learning; > > (iv) mobility; > > (v) self‑care; > > (vi) self‑management; and > > (d) the impairment or impairments affect the person's capacity for social or economic participation; and > > (e) the person is likely to require support under the National Disability Insurance Scheme for the person's lifetime. > > (2) For the purposes of subsection (1), an impairment or impairments that vary in intensity may be permanent, and the person is likely to require support under the National Disability Insurance Scheme for the person's lifetime, despite the variation. > > (3) For the purposes of subsection (1), an impairment or impairments that are episodic or fluctuating may be taken to be permanent, and the person may be taken to be likely to require support under the National Disability Insurance Scheme for the person's lifetime, despite the episodic or fluctuating nature of the impairments. > > (4) Subsection (3) does not limit subsection (2).
(a) intellectual function, particularly in visual and special intellectual abilities, visual abstract reasoning and block construction skills;[22] > > (b) attention and working memory, particularly attention span and his Working Memory Index (WAIS-IV) was in the 9th percentile;[23] > > (c) speed of information processing, including his ability to quickly match symbols and digit-symbol coding;[24] > > (d) memory and learning, including his ability to retain words and visual designs (Dr Wong reported his structured verbal memory was in the 1st percentile);[25] > > (e) executive function, particularly visual and verbal cognitive flexibility, inhibition switching, planning and organisation (Dr Wong reported his executive function was in the extremely low range ( > (f) basic reading skills (Dr Wong reported these were in the extremely low range consistent with a specific learning disorder);[27] > > (g) adaptive function, particularly in the conceptual domain (communication, functional academics and self-direction), the social domain (respect for persons in authority, good judgment in selecting friends, refraining from doing embarrassing things, expressing emotions, difficulty waiting his turn or following rules) and the practical domain (community use, home living, health, safety and self-care) (Dr Wong reported Mr Grac's global adaptive composite was in the low range (3rd percentile)).[28]
5.4 An impairment is, or is likely to be, permanent (see paragraph 5.1(b)) only if there are no known, available and appropriate evidence-based clinical, medical or other treatments that would be likely to remedy the impairment. > > 5.5 An impairment may be permanent notwithstanding that the severity of its impact on the functional capacity of the person may fluctuate or there are prospects that the severity of the impact of the impairment on the person's functional capacity, including their psychosocial functioning, may improve. > > 5.6 An impairment may require medical treatment and review before a determination can be made about whether the impairment is permanent or likely to be permanent. The impairment is, or is likely to be, permanent only if the impairment does not require further medical treatment or review in order for its permanency or likely permanency to be demonstrated (even though the impairment may continue to be treated and reviewed after this has been demonstrated). > > 5.7 If an impairment is of a degenerative nature, the impairment is, or is likely to be, permanent if medical or other treatment would not, or would be unlikely to, improve the condition.
No decision-maker need be satisfied a person's impairment is "serious", or more serious than another person's. No qualitative judgments in that sense are called for. Rather, the legislative scheme is based on a functional, practical assessment of what a person can and cannot do. Critically, the scheme makes detailed provision for that assessment, and it is sufficient for a person to have substantially reduced functional capacity in relation to one activity.[34] > > The statutory concept of "substantially reduced functional capacity" requires no assessment by the decision-maker of how common the reduction in functional capacity might be, or whether the way in which the reduced functional capacity manifests itself is something that can be seen in a certain number of people.[35]
5.8 An impairment results in substantially reduced functional capacity of a person to undertake one or more of the relevant activities - communication, social interaction, learning, mobility, self-care, self-management (see paragraph 5.1(c)) - if its result is that: > > (a) the person is unable to participate effectively or completely in the activity, or to perform tasks or actions required to undertake or participate effectively or completely in the activity, without assistive technology, equipment (other than commonly used items such as glasses) or home modifications; or > > (b) the person usually requires assistance (including physical assistance, guidance, supervision or prompting) from other people to participate in the activity or to perform tasks or actions required to undertake or participate in the activity; or > > (c) the person is unable to participate in the activity or to perform tasks or actions required to undertake or participate in the activity, even with assistive technology, equipment, home modifications or assistance from another person.
Communicating - how you speak, write, or use sign language and gestures, to express yourself compared to other people your age. We also look at how well you understand people, and how others understand you. > > Socialising - how you make and keep friends, or interact with the community, or how a young child plays with other children. We also look at your behaviour, and how you cope with feelings and emotions in social situations. > > Learning - how you learn, understand and remember new things, and practise and use new skills. > > Mobility, or moving around - how easily you move around your home and community, and how you get in and out of bed or a chair. We consider how you get out and about and use your arms or legs. > > Self-care - personal care, hygiene, grooming, eating and drinking, and health. We consider how you get dressed, shower or bathe, eat or go to the toilet. > > Self-management (if older than 6) - how you organise your life. We consider how you plan, make decisions, and look after yourself. This might include day-today tasks at home, how you solve problems, or manage your money. We consider your mental or cognitive ability to manage your life, not your physical ability to do these tasks. > > Your impairment substantially reduces your functional capacity if you usually need disability-specific supports to participate in or complete the above tasks. > > These disability-specific supports include:
_16. [Mr Grac's] identified impairments in executive function, memory and literacy (Extremely Low range,
> a. Communication - difficulties with social aspects of communication (e.g. talking too much, not listening closely to others), difficulties with reading and written communication, understanding and explaining complex/abstract concepts > > b. Social interaction - [Mr Grac] is very socially isolated and has difficulties making new friends, maintaining friendships, social problem-solving and overcoming social breakdowns. > > c. Learning - As a result of [Mr Grac's] ADHD, PTSD and learning disorders, has difficulties focusing attention, inhibiting irrelevant distractions, holding multiple-step instructions in mind, taking in new information, shifting attention between activities, and planning and organising his daily activities. Due to his family dynamics and learning difficulties, [Mr Grac] left school in Year 9 so has low levels of education. He has not been able to hold down any formal employment. > > d. Self-care - [Mr Grac] has very poor self-care skills and does not bathe regularly, brush his teeth, exercise or eat nutritious foods. > > e. Self-management - as a result of his diagnoses, [Mr Grac] has significant difficulties with self-management including time management, planning/completing everyday activities, and controlling and regulating his emotions. He requires assistance from other persons including occupational therapist and support workers to help develop and implement organisational skills, psychological support for emotion regulation, and assistance with home-living activities.[48]
I opine that Mr Grac's lack of engagement in meal preparation is due to self-management with regard to routine and structure and have therefore included intervention in section 5.1.6 below.[61]
These difficulties currently diminish his ability to independently function in home, social and learning environments.[63]
Because of [Mr Grac's] severe impairments listed above [including difficulties with executive function, learning, recalling new information, learning, self-care, self-management, social functioning and communication] he has been unable to engage in treatment which may be appropriate for other people who do not have those impairments. [Mr Grac] does not have the functional ability to organise or participate in those treatments of [sic] the organisational and self management skills to be able to appropriately organise and take medications safely.[64]
[Mr Grac] called maintenance when there was a plumbing issue with his unit and put measures in place to stem the flow. When a plumber was not able to come out immediately Mr Grac reportedly became frustrated and required support to work out what the next step would be. Mr Grac stated he can get overwhelmed at time with circumstances that arises [sic] and will ask for help "once or twice a month".[66]
Based on my observations, Mr Grac has the capacity for day-to-day planning, problem solving and making decision without assistance in routine circumstances. It appears that when novel or complex situations arise, he can become overwhelmed. In these circumstances he recognises the need for support and reaches out to known agencies for assistance. In my opinion, Mr Grac requires intermittent assistance in the domain of self-management in complex situations and when circumstances arise where he has to deal with government agencies or legal issues.[67]
You must be likely to need support under the NDIS for your whole life. > > NDIS supports are investments that help you build or maintain your functional capacity and independence, and help you work, study or take part in social life. > > Even if your needs go up and down over time, or happen episodically, we may still consider it's likely you'll need lifetime support under the NDIS. > > We consider your overall situation to answer this question. > > When we decide if you'll likely need support under the NDIS for your whole life, we consider: > > • your life circumstances > > • the nature of your long-term support needs > > • whether your needs could be best met by the NDIS, or by other government and community services. > > For example, you may have an impairment which is caused by a chronic health condition. Many chronic health conditions are most effectively managed or remedied through medical management through the health system. If this is the case, we may decide that you don't have a lifetime need for support under the NDIS.[68]
The focus of s 24(1)(e) is on whether a prospective participant is likely to require support under the NDIS, or whether those support needs are most appropriately met by other systems.[70]
[52] Although an impairment may, in general terms (and, for example, in the terms of Art 1 of the Convention on the Rights of Persons with Disabilities extracted above) be responsible for or related to a disability, the threshold in s 24 revolves around the severity and permanency of the effects of the impairments experienced by a person, so as to justify the provision of the "reasonable and necessary supports" to which participants may be entitled, after assessment in accordance with Pt 2 of Ch 3 of the Act.[71] > > [Original emphasis]
The Tribunal does not consider that it would be a proper interpretation of s 24(1)(e) to undertake an assessment of whether the supports required by Ms Sutherland could be provided by other service systems in order to decide whether this criterion is met. Rather, the wording of s 24(1)(e) simply requires the Tribunal to satisfy itself as to whether Ms Sutherland will require support under the NDIS for her lifetime, as per the wording of this provision. The Tribunal interprets this to mean that the Tribunal must focus on whether Ms Sutherland will need those supports under the NDIS for her lifetime and that this does not depend upon whether she can acquire the supports themselves elsewhere.[73]
(a) The construction of a statutory provision begins and ends with the statutory text understood in context and in light of the statutory purpose - being what the provision is designed to achieve in fact - insofar as that purpose is discernible from the statutory text and context.[75] > > (b) Focus on the statutory text is not to the exclusion of extrinsic material that has the potential to assist in fixing its meaning.[76]
(a) the person's long-term support needs to address the effects of permanent impairments; > > (b) whether the support needs can be funded or provided under the NDIS; > > (c) whether alternative systems exist under which the person's support needs might be funded or provided during the person's lifetime; and > > (d) whether the supports are likely to be most appropriately funded or provided under the NDIS or another system during the person's lifetime.
(1) A person meets the early intervention requirements if: > > (a) the person: > > (i) has one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be, permanent; or > > (ii) has one or more identified impairments to which a psychosocial disability is attributable and that are, or are likely to be, permanent; or > > (iii) is a child who has developmental delay; and > > (b) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by reducing the person's future needs for supports in relation to disability; and > > (c) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by: > > (i) mitigating or alleviating the impact of the person's impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, self‑care or self‑management; or > > (ii) preventing the deterioration of such functional capacity; or > > (iii) improving such functional capacity; or > > (iv) strengthening the sustainability of informal supports available to the person, including through building the capacity of the person's carer. > > Note: In certain circumstances, a person with a degenerative condition could meet the early intervention requirements and therefore become a participant. > > (1A) For the purposes of subparagraph (1)(a)(i) or (ii), an impairment or impairments that are episodic or fluctuating may be taken to be permanent despite the episodic or fluctuating nature of the impairments. > > (2) The CEO is taken to be satisfied as mentioned in paragraphs (1)(b) and (c) if one or more of the person's impairments are prescribed by the National Disability Insurance Scheme rules for the purposes of this subsection. > > (3) Despite subsections (1) and (2), the person does not meet the early intervention requirements if the CEO is satisfied that early intervention support for the person is not most appropriately funded or provided through the National Disability Insurance Scheme, and is more appropriately funded or provided through other general systems of service delivery or support services offered by a person, agency or body, or through systems of service delivery or support services offered: > > (a) as part of a universal service obligation; or > > (b) in accordance with reasonable adjustments required under a law dealing with discrimination on the basis of disability.
Plainly, as a matter of logic and statutory construction, if the early intervention supports required were not identified by the Tribunal, then the various considerations referred to in s 25(3) could not be properly assessed. In particular:
139. The phrase likely to require support under the [Scheme] in s 24(1)(e) must be read in context and construed for the purposes of the disability requirements, in which it is an essential precondition for the grant of access to the Scheme as a participant. In this context, it is not necessary or appropriate to make an assessment of the nature or extent of assistance the person may require under the Scheme, as such matters are relevant only after the person has been found to be a participant. For the same reason, it does not involve consideration of potential supports the person may require in the future with reference to the terms of s 33 or the factors set out in s 34 of the NDIS Act. > > 140. The question posed by s 24(1)(e) does not turn on the kind of assistance the person requires and whether such assistance may be available outside the Scheme, rather it turns on a finding about the likely duration of the person's requirement for support under the Scheme should they become a participant. Where the requirement is likely to be anything less than lifelong, the threshold is not met.
From this it follows, the decision under review must be set aside and in substitution the Tribunal decides Mr Grac satisfies the 'access criteria' for the purposes of s 20(1)(a) of the NDIS Act.
[21] DQKZ and National Disability Insurance Agency [2024] AATA 2276, [144]-[149].
[29] National Disability Insurance Agency v Davis [2022] FCA 1002, [85].
[36] National Disability Insurance Agency v Foster [2023] FCAFC 11, [65].
[39] [2020] AATA 4025, [79].
[40] [2021] AATA 727, [50].
[41] Respondent's Statement of Facts, Issues and Contentions, 21 August 2025, [27]-[28].