austlii:cth/ARTA/2025/874
General information, not legal advice.
ARTA
2025-06-24
Original judgment source is linked above.
Lawson and National Disability Insurance Agency (NDIS) [2025] ARTA 874 (24 June 2025)
Respondent: National Disability Insurance Agency
Decision: The Tribunal varies the reviewable decision as follows:
1. Mrs Lawson's Statement of Participant Supports will include funding for the following reasonable and necessary supports:
2. The plan is to be reassessed 12 months after the new plan is implemented following this decision.
In all other respects, Mrs Lawson's plan remains unchanged.
............................[SGD]...................................
NATIONAL DISABILITY INSURANCE SCHEME - NDIS supports - reasonable and necessary supports - consideration of s 34 National Disability Insurance Scheme Act 2013 - s 10(1) a support is an NDIS Support, if the is support declared an NDIS support under the rules - enquiry focusses on the support, not the participant, requires a two-stage process - standard household items, appliances, tools and products - standard item is not modified or adapted to address the functional impairments of the participant - effective and beneficial and current good practice - day-to-day living costs - value for money - physiotherapy equipment - pottery, cooking, painting and/or sewing classes - at home pathology services - dental care - mental health services- short term accommodation - physiotherapy hours - occupational therapy - additional dietician hours - agreement as to part of the proceeding - decision varied.
Administrative Review Tribunal (Consequential and Transitional Provisions No. 1) Act 2024 (Cth)
National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No 1) Act 2024 (Cth)
National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Cth)
National Disability Insurance Scheme (Getting the NDIS Back on Track No. 1) (NDIS Supports) Transitional Rules 2024 (Cth)
National Disability Insurance Scheme (Getting the NDIS Back on Track No. 1) (Miscellaneous Provisions) Transitional Rules 2024 (Cth)
McGarrigle v National Disability Insurance Agency [2017] FCA 308
National Disability Insurance Agency v WRMF [2020] FCAFC 79
Re Drake and Minister for Immigration and Ethnic Affairs (No 2) (1979) 2 ALD 634
Re FSWN and National Disability Insurance Agency [2025] ARTA 114
(1) For the purposes of specifying, in a statement of participant supports, the general supports that will be provided, and the reasonable and necessary supports that will be funded, the CEO must be satisfied of all of the following in relation to the funding or provision of each such support:
(aa) the support is necessary to address needs of the participant arising from an impairment in relation to which the participant meets the disability requirements (see section 24) or the early intervention requirements (see section 25);
(a) the support will assist the participant to pursue the goals, objectives and aspirations included in the participant's statement of goals and aspirations;
(b) the support will assist the participant to undertake activities, so as to facilitate the participant's social and economic participation;
(c) the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support;
(d) the support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice;
(e) the funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide;
(f) the support is an NDIS support for the participant.
(2) The National Disability Insurance Scheme rules may prescribe methods or criteria to be applied, or matters to which the CEO is to have regard, in deciding whether or not he or she is satisfied as mentioned in any of paragraphs (1)(aa) to (f).
3.1 In deciding whether the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support, the CEO is to consider the following matters:
(a) whether there are comparable supports which would achieve the same outcome at a substantially lower cost;
(b) whether there is evidence that the support will substantially improve the life stage outcomes for, and be of long-term benefit to, the participant;
(c) whether funding or provision of the support is likely to reduce the cost of the funding of supports for the participant in the long term (for example, some early intervention supports may be value for money given their potential to avoid or delay reliance on more costly supports);
(d) for supports that involve the provision of equipment or modifications:
(i) the comparative cost of purchasing or leasing the equipment or modifications; and
(ii) whether there are any expected changes in technology or the participant's circumstances in the short term that would make it inappropriate to fund the equipment or modifications;
(e) whether the cost of the support is comparable to the cost of supports of the same kind that are provided in the area in which the participant resides;
(f) whether the support will increase the participant's independence and reduce the participant's need for other kinds of supports (for example, some home modifications may reduce a participant's need for home care).
Effective and beneficial and current good practice
3.2 In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to consider the available evidence of the effectiveness of the support for others in like circumstances. That evidence may include:
(a) published and refereed literature and any consensus of expert opinion;
(b) the lived experience of the participant or their carers; or
(c) anything the Agency has learnt through delivery of the NDIS.
3.3 In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to take into account, and if necessary, seek, expert opinion.
5.1 A support will not be provided or funded under the NDIS if:
(a) it is likely to cause harm to the participant or pose a risk to others; or
(b) it is not related to the participant's disability; or
(c) it duplicates other supports delivered under alternative funding through the NDIS; or
(d) it relates to day-to-day living costs (for example, rent, groceries and utility fees) that are not attributable to a participant's disability support needs.
5.2 The day-to-day living costs referred to in paragraph 5.1(d) do not include the following (which may be funded under the NDIS if they relate to reasonable and necessary supports):
(a) additional living costs that are incurred by a participant solely and directly as a result of their disability support needs;
(b) costs that are ancillary to another support that is funded or provided under the participant's plan, and which the participant would not otherwise incur.
The [Supports Rules] are an important element of the legislative scheme, introducing the ability to modify the operation of ss 33 and 34 by, for example, excluding certain kinds of supports from inclusion in participant plans. It is through the Rules that the executive is able to implement...some policy decision-making about the nature and extent of supports to be provided or funded.
Whether a support is "reasonable" requires a different assessment to whether a support is "necessary"...the word "reasonable" would appear to be directed at factors such as those set out in s 34(1)(c) and (f). That is not to say the meaning of each word is exhausted by the factors set out in s 34(1): rather, it is to illustrate the different work that each concept does as an adjective in the phrase "reasonable and necessary supports".[5]
TGA approved medical vaporiser (for medical cannabis)
NutriBullet blender, vacuum sealer and bags, fridge and freezer
Physiotherapy equipment: yoga mat, massage gun, acupuncture mat, neck stretcher, back stretcher, resistance bands TheraBand and TENS machine
Hearing assistive technologies, maintenance and related costs
In circumstances where Mrs Lawson has not accessed the available budget for occupational therapy, and in the absence of evidence of a program detailing the goals to be achieved, and expected time frames, the Tribunal is not satisfied, on balance, that additional hours represent value for money under paragraph 34(1)(c) of the NDIA Act. Therefore, the requested support is not reasonable and necessary under subsection 34(1) of the NDIS Act.
85. The Tribunal varies the reviewable decision as follows:
In all other respects, Mrs Lawson's plan remains unchanged.
[3] National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Act 2024 Item 129 of Part 3 of Schedule 1.
[5] [2017] FCA 308 at [43].
[7] Re Drake and Minister for Immigration and Ethnic Affairs (No 2) (1979) 2 ALD 634.
[21] Re FSWN and National Disability Insurance Agency [2025] ARTA 114.
[22] Re FSWN and National Disability Insurance Agency [2025] ARTA 114 at [43].