Lloyd and National Disability Insurance Agency (NDIS) [2025] ARTA 2064 | Case summary

Lloyd and National Disability Insurance Agency (NDIS) [2025] ARTA 2064 | Case summary | Zoe

[29]

The issue to be determined in this case is whether the Applicant, Ms Lloyd, should be granted access to the National Disability Insurance Scheme (NDIS) and therefore be able to access NDIS supports.
In August 2023, the National Disability Insurance Agency (the Agency) refused Ms Lloyd's request to access the NDIS, and she applied to the former Administrative Appeals Tribunal (AAT) to independently review the merits of the Agency's decision. In 2024, the Administrative Review Tribunal (ART) was established to replace the AAT, the AAT was abolished, and Ms Lloyd's application was transferred automatically to the ART[1].
Ms Lloyd is 24 years of age. She lives on her own in Melbourne in a unit owned by her parents[2]. She is employed part time casual in retail and has a boyfriend. Her parents and younger sister live nearby in the family home. Her parents work full time. Her mother lives with relapsing, remitting multiple sclerosis.
Ms Lloyd lives with medical conditions which impair her ability to function. They include major depressive disorder (MDD), generalised anxiety disorder (GAD) and attention deficit/hyperactivity disorder (ADHD) [3].
This decision is, in essence, about whether the impairment, being the loss or damage to Ms Lloyd's neurological and psychological function that arises from her medical conditions, is of such nature and extent that she meets either the disability requirements in section 24 of the National Disability Insurance Scheme Act 2013 (the Act) or the early intervention requirements in section 25 of the Act.
The Tribunal recognises that Ms Lloyd has impairments that impact her daily life[4]. They impact her relationships with family members, her employment and her sense of self. Nonetheless, the Tribunal has found that Ms Lloyd's impairments, whilst permanent or likely to be so, do not result in the substantial reduction in functional capacity that gaining lifelong access to the NDIS requires. The Tribunal is satisfied, however, there are early intervention occupational therapy supports that are likely to benefit Ms Lloyd by reducing her future need for supports.
In summary, the Tribunal has determined Ms Lloyd does not meet the disability requirements but does meet the early intervention requirements. She therefore meets the access criteria in section 21 of the Act and the decision under review is set aside.
How the Tribunal has reached this decision, including its procedure, the evidence it has reviewed, the facts it accepts and the law it has applied, are set out below.

[35]

(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;

(ii) has one or more identified impairments to which a psychosocial disability is attributable and that are, or are likely to be, permanent;

(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.

(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

(d) in accordance with reasonable adjustments required under a law dealing with discrimination on the basis of disability.

[38]

The Tribunal must apply the relevant jurisprudence of the courts in access matters. The key principles that have been developed by the courts and are applied by the Tribunal are set out below.
The courts have said that the purpose of the access criteria and section 24(1) is to impose a series of "components and thresholds" [8] to gaining access to the NDIS. Given Ms Lloyd must satisfy every component in section 24(1), the Tribunal's approach is to consider whether each is in turn is satisfied before progressing to the next. If she fails to satisfy one, then she cannot meet the disability requirements, and the Tribunal must turn its attention to whether Ms Lloyd meets the early intervention requirements. The components of section 25 are also cumulative, and each must in turn be satisfied.
The courts emphasise that the central concept in an access matter is "impairment"[9]. It is not the name of a person's disability or their medical diagnoses or conditions[10]. Impairment has been defined to involve the loss of or damage to a physical, sensory or mental function[11].
The Tribunal must determine the permanency and severity of the applicant's impairments and the impact on the applicant's ability to undertake specified, multi-faceted life activities[12].
As to the requirement of permanency, which is present in both sections 24 and 25 of the Act, the courts have said "permanent" means "enduring"[13]. Further, an impairment may be enduring even if it fluctuates, or it may fluctuate, during a person's lifetime, in its intensity and its impact[14].
When considering whether an impairment or impairments result in substantially reduced functional capacity, the Tribunal must make, with a high degree of precision, a functional, practical assessment of what the applicant can and cannot do[15]. The Tribunal must assess the degree to which the applicant can participate in the life activity[16]. That assessment involves consideration of the full range of tasks and actions that comprise each of the life activity areas[17]. It would be incorrect to undertake this assessment only in relation to one or a few of such tasks[18]. It would also be incorrect to focus on what the person does not do, as opposed to what they cannot do[19].
The term 'substantially' in this context carriers a "high threshold"[20]. Whether this high threshold is met should be considered with reference to the purposes of the NDIS, including that it was not intended to provide support to every person with disability, and ensuring the scheme is financially sustainable[21]. The NDIS has as its target group limited sub-categories of the total population of people with disability in Australia[22]. The Tribunal emphasises these principles in response to Mrs Lloyd's evidence of her understanding the NDIS is available to all Australians with permanent disability. The presence of the additional requirements in sections 24(1)(c) to (e) also plainly illustrates the requirements to access the NDIS go beyond permanency.
As to the early intervention requirements, it is s pre-condition of being able to satisfy the requirements in section 25(3) that the required early intervention supports be identified[23]. The Tribunal cannot speculate as to the early intervention supports an applicant might receive and reach views under section 25 based on hypothetical supports[24]. It follows that the evidence before the Tribunal must identify and reason in favour of the supports sought and their likelihood of reducing the applicant's need for future supports.
Regarding the Tribunal's approach to the evidence, it is required to engage in a fact-finding exercise and examine the evidence of medical practitioners, clinicians, the applicant and their supports[25]. It is for an applicant to provide the Tribunal with sufficient evidence and information to persuade the Tribunal that they meet the access criteria[26]. It is for the Agency to assist the Tribunal to make the correct or preferable decision[27].
Relevant jurisprudence concerning the Access Rules is discussed below.

[41]

On an unknown date, using an access request form dated 9 January 2023[31], Ms Lloyd made a request to the Agency to access the NDIS (the access request)[32].
On 27 June 2023, the Agency refused the access request[33] (the access decision). The Agency gave few reasons in the decision record. It appeared to accept Ms Lloyd has one or more impairments to which a psychosocial disability is attributable[34] though it did not define the impairments. It accepted Ms Lloyd had been diagnosed with Major Depressive Disorder (MDD) and Generalised Anxiety Disorder (GAD). The Agency did not accept, however, that Ms Lloyd's impairments arising from those conditions are, or are likely to be permanent[35]. Accordingly, it found that Ms Lloyd did not meet either the disability or the early intervention requirements[36].
Ms Lloyd then applied to the Agency for an internal review of that decision, on 27 June 2023[37], and on 7 August 2023, the Agency again determined not to grant her access (the internal review decision)[38]. The internal review decision is the decision that is under review by the Tribunal.
In the internal review decision, the Agency again accepted Ms Lloyd has impairment to which a psychosocial disability is attributable[39]. In addition, it accepted Ms Lloyd's diagnosis of ADHD and that it gives rise to a disability attributable to a neurological impairment[40]. However, it again found that none of Ms Lloyd's impairments are or are likely to be permanent[41]. The Agency reasoned this was because, in relation to Ms Lloyd's psychosocial impairments, and based on her psychiatrist's opinion, "optimal treatment has not yet been achieved"[42]. It reached a similar conclusion in relation to Ms Lloyd's neurological impairment, stating that not all available and recommended treatments had been completed to enable permanency or likely permanency to be determined[43]. It followed that Ms Lloyd could not meet the early intervention requirements either and they were not considered.
On 17 August 2023, Ms Lloyd applied to the Administrative Appeals Tribunal (AAT) for a review of the internal review decision[44]. Her application had been progressing unsuccessfully through alternative dispute resolution until December 2024, when it was constituted to me for hearing and final determination. The Tribunal is satisfied the application to the AAT is valid and the ART has jurisdiction to determine it[45].

[42]

On 7 and 11 April 2025, the Tribunal conducted a two-day hearing by Ms Teams video conferencing. Ms Lloyd represented herself with assistance and support from her mother, Mrs Marguerite (Maggie) Lloyd. The Agency was represented by Ms Stephanie Clancy as counsel and instructed by Moray & Agnew Lawyers.
Ms Lloyd and the Agency agree on the documents the Tribunal should consider in making its decision. A Joint Tender Bundle (JTB), Supplementary Tender Bundle (STB) of documents and an internal Agency technical advice (Exhibit 3) were given to the Tribunal between 2 and 4 April 2025 and admitted into evidence at the hearing. They include the documents held by the Agency at the time Ms Lloyd made the Tribunal Application, including the documents the Agency relied on in making the internal review decision, and evidence later obtained by the parties for this proceeding, including voluminous clinical records. The Tribunal was not assisted by the parties' late filing of some 800 pages of evidence two days before the hearing and in non-compliance with its directions to file by 24 March 2025. Ms Lloyd did not comply with the Tribunal's direction to file any new statements by 14 February 2025. The Tribunal was asked by both parties to take into consideration the complete clinical records provided to it and has done so.
On Day One of the hearing, the Tribunal heard evidence from Ms Lloyd and her treating psychiatrist, Dr James Meyer-Grieve. On Day Two, the Tribunal heard further from Ms Lloyd, and took evidence from Mrs Lloyd and Mr Elliot Mate, the occupational therapist who conducted an independent functional assessment of Ms Lloyd at the Agency's instruction[46].
Ms Lloyd relies on documents including:
- two statements by her of lived experience, dated 29 November 2024 and April 2025
- three carer impact statements by Mrs Lloyd and dated 9 January 2023 (2023 statement), 10 November 2024 (2024 statement) and April 2025 (2025 statement).
The Tribunal observes there was no written statement from Ms Lloyd in support of either the access or the internal review request.
Ms Lloyd also relies on a fourth statement by Mrs Lloyd dated simply "November 2024" titled "statement of lived experience from carer's experience" (Mrs Lloyd's response to Agency), written in response to questions asked of Ms Lloyd by the Agency during ADR designed to explore her functional capacity.
Ms Lloyd seeks to rely on a fifth "statement" by Mrs Lloyd, being a series of electronic comments placed on Mr Mate's report. No printable nor readable PDF version of this document was provided to the Tribunal making the Tribunal's task of understanding it difficult. The Tribunal has determined to give these comments little weight, as there is no discernible narrative, and it is unclear the purpose for which they were provided to the Tribunal given the directions made by the Tribunal enabling statements to be filed and the number of statements filed by Mrs Lloyd. The comments appear only to be reactions to Mr Mate's observations.
The Tribunal observes that Mrs Lloyd overshadowed Ms Lloyd in the proceeding. If found this to be unhelpful to the Tribunal and unhelpful to Ms Lloyd. The Tribunal notes the comments of Dr Matthews in her clinical records suggesting this complex dynamic may be longstanding and driven by multiple factors. The Tribunal notes Dr Matthews' observation during her first appointment with Ms Lloyd in 2015 that Mrs Lloyd spoke a lot for Ms Lloyd "when in fact it didn't seem necessary"[47]. Other records describe Ms Lloyd's reliance on Mrs Lloyd to fix things for her, to merge her identity with hers and unwillingness to accept responsibility[48].
The Tribunal notes that Mr Lloyd, Ms Lloyd's father and co-parent, did not give evidence in the proceeding and his views on the application are unknown.
The Tribunal notes there is no evidence from Ms Lloyd's employers despite claims concerning Ms Lloyd's functional and social difficulties at work and her consequently being at risk of discriminatory dismissal from employment.
The medical and clinical reports and records Ms Lloyd relies on include:
- neurological assessment report from Dr Michelle Lindsay-Dawe, Clinical Neuropsychologist, dated February 2021
- reports and treatment records from Dr James Meyer-Grieve, Child and Adolescent Psychiatrist, including reports dated November 2023, November 2024 and clinical records created during the 3-year period February 2021 to January 2024
- joint reports from Dr Meyer-Grieve and Dr Catherine Matthews, Senior Clinical Psychologist, dated November 2022 and May 2023
The Tribunal observes that Ms Lloyd has had largely enduring relationships with the practitioners below whose reports and records are before the Tribunal. The Tribunal has considered the longstanding nature of these relationships in its task of assessing the weight to be given to their evidence:
- Dr Catherine Matthews, from 2015 until the present day[49], or some 10 years.
- Dr James Meyer-Grieve, from 2020, or 5 years.
Doctors Lindsay-Dawe and Matthews did not give evidence at the hearing. The Tribunal notes that Dr Matthews remains Ms Lloyd's treating psychologist, and that Dr Matthews did not produce or co-author a new report for the purposes of this proceeding.
The Agency relies on two reports prepared by Mr Elliot Mate. Mr Mate is the expert witness who has most closely and recently assessed Ms Lloyd's functional capacity. He is the only independent expert to address this issue. His principal report is dated 26 June 2024 and records the findings of his assessment of Ms Lloyd in her home on 6 June 2024[50]. The Tribunal notes and accepts the report was prepared in accordance with the AAT Guideline for Expert Opinion and Evidence[51]. Mr Mate's second and supplementary report, dated 17 February 2025, was prepared on instruction from the Agency to address comments from Dr Meyer-Grieve on Mr Mate's first report. It was explained to the Tribunal that Exhibit 3 is an internal Agency advice addressing only Mr Mate's supplementary report. It was accepted into evidence by the Tribunal on the basis that it is to be considered submissions only and on the Agency's assurance that little if any weight should be given to it. Ms Lloyd had not had an opportunity to consider it in detail prior to the hearing.
Regarding submissions, the Agency provided a pre-hearing Statement of Facts, Issues and Contentions (SFIC) dated 24 February 2025 outlining the key arguments in its case. Ms Lloyd was also invited to make pre-hearing written submissions but was not required to do so. She did not provide a dedicated document however the April statements from herself and Mrs Lloyd are acknowledged to contain argument as well as evidence. Ms and Mrs Lloyd made oral closing submissions. There was insufficient time for the Agency to make oral closing submissions within the hearing as listed. Accordingly, the Agency provided their closing submissions in writing on 24 April 2025. The Tribunal has had regard to all the materials and oral evidence before it.
As Ms Lloyd did not have legal representation, the Tribunal ensured hearing time was dedicated to her testimony. The Tribunal was flexible and as informal as the proceeding allowed and encouraged Ms Lloyd to request breaks above those scheduled as needed. Breaks were requested and provided.

[43]

Ms Lloyd claims to meet the access criteria are substantially focused on her claims to meet the disability requirements in section 24 of the Act.
Prior to the hearing, the Agency conceded the evidence demonstrates Ms Lloyd meets the permanency requirements in sections 24(1)(b)[52]. In summary, it contends Ms Lloyd meets the criteria in section 24(1)(a), (b) and (d) but not (1)(c) and (e) [53].
The Agency submits that the question of whether Ms Lloyd meets the requirements of section 24(1)(c) is at the heart of the matter[54]. Practically, the key issue before the Tribunal is to assess the merits and reliability of the competing expert evidence before it. The Agency agreed with Ms Lloyd that the relevant expert evidence before the Tribunal was not limited to Mr Mate's and included the clinical records before the Tribunal that may assist the Tribunal to determine what tasks and functions Ms Lloyd can do independently and distinguishing between what she does not do and cannot do[55].
The early intervention requirements were little addressed by the parties prior to hearing.
Ms Lloyd did not make submissions to the Tribunal expressly directed to the early intervention requirements or make claims in her access request to meet the early intervention requirements[56]. At a Tribunal case management event in December 2024, Mrs Lloyd informed the Tribunal that Ms Lloyd could not pursue early intervention supports as she has received them since childhood. Whilst the Tribunal respects that position it notes that evidence was given to the Tribunal by both parties relevant to section 25 of the Act. The Tribunal does not expect an unrepresented applicant to fully understand the legal avenues and requirements relevant to her circumstances and the Tribunal considers it must assess the claims arising from the evidence before it even if not so framed by an applicant in accordance with the law.
The Agency's position is that there is insufficient evidence before the Tribunal which would enable a finding that the provision of early intervention supports is likely to benefit Ms Lloyd by reducing her future needs for supports in relation to her disability. It submits the requirements of section 25 of the Act are not met. Its more detailed contentions are addressed in the Tribunal's consideration of whether Ms Lloyd meets the early intervention requirements below.

[54]

The Tribunal accepts the Respondent's submission that this evidence from Dr Meyer-Grieve is consistent with Dr Lindsay-Dawe's 2021 assessment of Ms Lloyd's impairments[68]. Dr Lindsay-Dawe also diagnosed impairments in attention and executive function by observing and deducing deficits in working memory, attention, processing speed, inhibition, emotional regulation, flexible thinking, and holding and weighing information in mind[69].
Dr Lindsay-Dawe reports a Sensory Processing Disorder was diagnosed at approximately eight years of age[70]. There is mention of Ms Lloyd experiencing Tics at that time, though it is unclear from this report if that was the basis for the diagnosis[71]. Although Drs Matthews and Meyer-Grieve reiterate the diagnosis in November 2022[72], the Tribunal is not on the balance of the evidence before it persuaded the diagnosis remains current and clinically distinct from the diagnoses above. It understands the evidence of Dr Meyer-Grieve at hearing to be that Ms Lloyd's sensory sensitivities come within her ADHD diagnosis. In the Tribunal application[73] and elsewhere in her evidence, Ms Lloyd does not object to the Agency not having accepted the diagnosis in the Internal Review Decision. In their subsequent May 2023 report, Drs Matthews and Meyer-Grieve focuses on treatments since 2014 for GAD, MDD and ADHD only[74]. Dr Meyer-Grieve in his November 2023 and November 2024 does not address this diagnosis. Further, there is insufficient evidence before the Tribunal as to whether the diagnosis, even if current, is causative of impairments in addition to those discussed above.
The Tribunal notes that at hearing, claims emerged concerning aggression by Ms Lloyd in the family home. Mrs Lloyd explained to the Tribunal this is why Ms Lloyd was moved out of the family home and into the investment property where she now lives. The difficulty for the Tribunal is that the claims are only euphemistically raised by Mrs Lloyd in her statements as "behavioural challenges"[75]. Ms Lloyd does not raise them and there are no claims before the Tribunal that Ms Lloyd is aggressive outside of the family home. The claims are not addressed in the medical and clinical reports before the Tribunal, particularly the evidence of Dr Meyer-Grieve, who is Ms Lloyd's principal witness as to her diagnoses, impairments and symptoms. Further, there is evidence in the clinical notes of Dr Matthews that Ms Lloyd's aggression is something she has control over and is the product of bad choices[76]. As there is no reliable expert and objective report before the Tribunal that speaks to whether this claimed behaviour is associated with Ms Lloyd's accepted impairments, the Tribunal is not satisfied that it is.
Based on the above expert evidence, the Tribunal finds that Ms Lloyd has a neurological impairment of executive dysfunction arising from an ABI acquired at birth with symptoms of ADHD including impaired emotional regulation[77], working memory[78], processing speed, flexible thinking, holding and weighing information in mind, fatigue[79], attentional functioning[80] and sensory sensitivity. It finds Ms Lloyd has a psychosocial disability resultant from GAD and persistent MDD. It accepts Ms Lloyd's neurological impairment underpins her psychosocial impairments of GAD and MDD, with symptoms including anxiety, fatigue and reduced motivation[81]. The impairments combined result in symptoms. Tribunal considers the impacts of these symptoms in assessing section 24(1)(c).

[59]

In relation to whether an impairment is likely to be permanent, the Access Guideline reflects the jurisprudence of the courts and relevantly state:
- We need to know whether your impairments are enduring so that you require NDIS supports on an ongoing basis.
- We will focus on your impairments, and not on the cause of your impairments, or your diagnoses.
- Even when your condition or diagnosis is permanent, we'll check if your impairment is permanent too. For example, you may not be eligible if your impairment is temporary, or if there are known, available and appropriate evidence-based clinical, medical or other remaining treatments options that are likely to remedy the impairment.
- Generally, we'll consider whether your impairment is likely to be permanent if all available and appropriate treatment options are pursued.
- Your impairment will likely be permanent if your treating professional tells us there are no further treatments that could remedy it.
- Your treating professional will tell us or be asked to certify if there are medical, clinical or other treatments that are likely to remedy your impairment. We need to understand whether there are treatments that are:
  - known - the treatment can be identified by an Australian medical practitioner as a suitable treatment for your impairment
  - available to you - we need to take account of whether there are genuine barriers that prevent you from accessing treatment including, but not limited to, the nature of your impairment and your ability to access treatment
  - appropriate for you and your impairment - we need to consider whether the treatment could remedy your impairment and is suitable and safe for you to undergo. Your ability to undergo treatment will be assessed according to your capabilities, your health and other personal circumstances, including your living arrangements
  - evidence-based - there's proof the treatment is likely to be effective.
- When we look at what treatments are available to you, we think about whether the treatment is suitable for your personal situation. The word treatment should be understood in a broadest sense and may include changes to your diet and lifestyle.
- If you're still undergoing or have recently had treatment, we may not be sure you have a permanent impairment if that treatment could remedy the impairment.
- In some situations, it may be clear your impairment is likely to be permanent while you're still undergoing treatment or rehabilitation. For example, you may still need treatment and rehabilitation for a spinal cord injury, but it's clear you are likely to have a permanent impairment.
List B in the Access Guideline states the conditions the Agency accepts as likely to result in permanent impairment. The Tribunal notes that List B does not include an ABI per se but does include hydrocephalus[87]
The Tribunal notes that the focus of Rules 5.4 and 5.6 is on medical and clinical treatment. These statutory provisions require the Tribunal to consider what treatment is available and suitable and if so, the likely outcomes of Ms Lloyd undertaking it. These rules indicate that consideration of any treatment Ms Lloyd has had to date for his impairments is integral to these considerations. This is further emphasised by the references to the importance of information from treating professionals in the above extracts from the Access Guideline.

[60]

Drs Matthews and Meyer-Grieve are Ms Lloyd's primary treating professionals. Their evidence carries most weight in the assessment of permanency. As the Tribunal has noted above, these treating relationships are longstanding. Further, the summons records and oral evidence satisfy the Tribunal that Ms Lloyd has received approximately fortnightly treatment from Dr Matthews and monthly from Dr Meyer-Grieve for the duration of those relationships to date, with additional appointments to manage crises. This weighs in support of permanency. The Tribunal accepts from the evidence of both doctors that their combined treatment is both pharmacological and psychology. Their summons records indicate that the services of both are at least partially funded by Medicare[88], with Ms Lloyd attending Dr Matthews under a Mental Health Plan.
Much of the foundational evidence in support of permanency is addressed above in the Tribunal's determination of the impairments. The Tribunal understands that the experiences of both practitioners in treating Ms Lloyd have assisted to shape their underlying diagnoses.
Dr Lindsay-Dawe noted in November 2021 that many of Ms Lloyd's childhood treatments were early interventions in physiotherapy, OT and speech pathology[89]. Dr Matthew's notes in April 2015[90] that despite early milestones being delayed "she has mostly caught up and a cognitive assessment in 2009 revealed average verbal and perceptual reasoning skills, with low average working memory and processing speed"[91].
In their November 2022 report, Drs Matthews and Meyer-Grieve only briefly cover treatment. They also note that Ms Lloyd has engaged in various multi-disciplinary therapeutic treatments since childhood but do not elaborate[92].
In their May 2023 report, Drs Matthew and Meyer-Grieve provide a detailed discussion of treatments. They note that Ms Lloyd's multidisciplinary treatments since early childhood have not led to significant improvement[93] and opine it is unlikely Ms Lloyd's executive dysfunction can be cured given its origins in childhood changes in brain development[94]. They note that since Dr Matthews commenced treatment that Ms Lloyd has undergone all the main evidence-based treatments for depression and anxiety[95] and that her MDD is currently in partial remission[96]. They detail medication and psychology treatments applied and reasons for their limited success and conclude that mild improvements at best are expected in her diagnosed conditions with ongoing treatment and intensive adult/carer support[97].
In his November 2023 report[98], Dr Meyer-Grieve describes Ms Lloyd's executive function deficits as chronic and severe. He opines that Ms Lloyd's impairments are permanent and resistant to pharmacological treatment. He explains that because the "psychiatric diagnoses are secondary to Jasmine's neuropsychiatric disorder, usual interventions will be partially effective at best, with all evidence-based best-practice interventions having been already attempted".
Dr Meyer-Grieve reaffirmed these opinions at hearing stating that the "ADHD ...pharmacological interventions that are usually so successful for young people have been disappointing for Jasmine". He affirmed that "Jasmine's' emotional regulation difficulties associated with this executive disorder give rise to her depression and her anxiety, which have also proved treatment resistant". He described the evidence of Ms Lloyd's impairment as being "lifelong". He provided a detailed explanation at hearing of the relationship between Ms Lloyd's executive dysfunction and her emotional dysregulation, particularly heightened and constant anxiety, enormous relational anxiety, consequential cognitive impairment, regular overwhelm and depression.
The Tribunal finds the above expert evidence to be persuasive. It accepts on the medical evidence that Ms Lloyd's neurological and psychosocial impairments as described above are permanent. The Tribunal is satisfied that there are no known, available and appropriate evidence-based clinical, medical or other treatments that would be likely to remedy these impairments. It is satisfied they do not require further medical treatment or review for their permanency or likely permanency to be demonstrated.

[68]

It is helpful to reiterate the principles developed in court and Tribunal decisions about the assessment under section 24(1)(c) that are particularly relevant to Ms Lloyd's case.
The Tribunal must assess Ms Lloyd's functional capacity in carrying out the full range of tasks and actions that comprise each of the life activity areas[106]. Ms Lloyd cannot satisfy Rule 5.8 or section 24(1)(c) if there is only one, or only a few, tasks within the activity area that she forgoes altogether, or cannot complete without assistive technology or the assistance of another[107], or in respect of which her functional capacity is otherwise substantially reduced. As discussed below, there are some tasks for which Ms Lloyd does require a level of assistance from others to complete.
Further, that Ms Lloyd undertakes some tasks differently and more slowly that others because of her permanent impairments, does not necessarily mean she cannot participate effectively or completely in an activity area without assistance or that her functional capacity is otherwise substantially reduced[108]. As discussed below, there are tasks that Ms Lloyd does more slowly than others because of her permanent impairments.
Lastly the Tribunal's focus must be on what Ms Lloyd cannot do, not on what Ms Lloyd does not do[109]. One of the pivotal issues in this proceeding is whether the Tribunal has sufficient, reliable evidence before it to determine, in respect of tasks or activities that are done sometimes or often for Ms Lloyd by her parents, whether that is because Ms Lloyd cannot carry out the task or activity herself due to her impairment, or for reasons unrelated to her impairment. The question of whether an applicant's functional capacity is reduced in a particular domain must be answered only with reference to those impairments the Tribunal has defined them and accepted as permanent. In some significant part, the Tribunal's analysis below is dedicated to exploring the reliability of such relevant evidence before it on this issue.

[71]

The Tribunal agrees with the Agency's submission that care should be taken when assessing the weight to be given to the opinions of Drs Matthews and Meyer-Grieve on Ms Lloyd's functional capacity in their November 2022 report that cannot clearly be related to the activity areas[110]. The Tribunal also accepts that less weight should be accorded to it because it focuses only on what Ms Lloyd has difficulties with, that is in terms of the legal principles, only on what she cannot do and not also on what she can do. There are, however, more serious concerns with this report.
Ms Lloyd confirmed at hearing that the section on Functional Impairments was drafted based on notes provided by her and by Mrs Lloyd to Dr Matthews. This is corroborated in Dr Matthews' records dated 27 September and 18 October 2022. However, this methodology is not disclosed by Drs Matthews and Meyer-Grieve in the report itself. On its face, the report purports to be solely their own expert opinions based on their interactions with Ms Lloyd during treatment. This significantly undermines the credibility of the report. Dr Meyer-Grieve was unconvincing in his oral evidence that he had contributed to this aspect of the report based on an assessment he had conducted with Ms Lloyd and there is no record of such in his clinical notes. He gave no indication to the Tribunal that he was aware that Dr Matthews had asked Ms and Mrs Lloyd to provide her with the content on functional capacity. The Tribunal understands from his oral evidence is that he believed the content to have come from Dr Matthews and that he signed the report on the basis it was not inconsistent with his own observations of how Ms Lloyd functions.
As Dr Matthews did not give evidence, the way in which the report was compiled and the extent to which the opinions on functional impairments are to any extent hers cannot be known. That Dr Matthews turned to Ms and Mrs Lloyd for the report's content on functional impairment causes the Tribunal to doubt the extent to which issues relating to functional impairment had arisen during her treatment of Ms Lloyd over the preceding seven years. The Tribunal is unable to identify a reliable correlation between the content of the report and Dr Matthews' detailed clinical notes. For these reasons, the Tribunal does not give weight to this section in the report, as the author and provenance of the content is unknown.
The Tribunal understands from his oral testimony that Dr Meyer-Grieve has since refined his opinions and distanced himself from the November 2022 report.

[72]

As is discussed above, the Tribunal has accepted Dr Meyer-Grieve's diagnostic evidence and found his oral testimony of assistance in understanding the interrelationships between Ms Lloyd's impairments and her symptoms. In so far as the Tribunal is satisfied his opinions relate to his expert assessment of Ms Lloyd within his field of clinical expertise as a psychiatrist, and are based upon her presentations, the information she has given and the diagnostic assessments undertaken in treatment sessions with him, the Tribunal gives weight to them.
The Tribunal approaches Dr Meyer-Grieve's evidence in his November 2024 report regarding the extent of Ms Lloyd's functional capacity with considerable caution, however. The assessment of functional capacity is not Dr Meyer-Grieve's area of clinical expertise. The Tribunal has no clinical records of him conducting functional capacity assessments or related tests and it is unclear to the Tribunal as to from where his factual claims regarding the type, level and motivation for and outcomes of supports given to Ms Lloyd by her parents are derived. The Tribunal has reviewed Dr Meyer-Grieve's clinical notes from which it appears Ms Lloyd was accompanied by one or both parents in approximately five treatments over the two-and-a-half-year period April 2021 to December 2023, the latter being the most recent clinical note before the Tribunal. Mrs Lloyd told the Tribunal she seldom attends these appointments. There is negligible information in these notes about the supports provided to Ms Lloyd by her parents as reported to him. The Tribunal accepts the Agency's submissions regarding the lack of a file review of Dr Matthew's clinical notes and the generality of his opinions further contribute to their unreliability[111].
To the extent to which the claims made by Dr Meyer-Grieve might be taken as accurate statements about the level or extent of parental supports given to Ms Lloyd, the evidentiary basis for his apparent assumption that such supports are provided and needed solely for the reason of her impairments is not explained and there is no evidence before the Tribunal that he has tested those assumptions.
The Tribunal accepts the Agency's submission that it is not possible for the Tribunal to separate out emotional and parental support from any practical support, assistance, guidance, supervision or prompting that Ms Lloyd requires to complete a daily activity[112]. This is made the more problematic given Dr Meyer-Grieve's own observations that Ms and Mrs Lloyd have a disregulatory relationship[113].
The Tribunal adds, in a more objective sense, that the fact someone does a task for a person is not a reliable indicator the person needs the task to be done for them. It may be a choice of the giver to perform the task and a choice by the receiver to allow it to be done for them because this is, for example, preferable to them doing it themselves, they have no significant interest in the task, they like the person to be around, the giver is dominant, they are co-dependent and so on. Where the giver is a parent and the receiver their child, choice is likely to be a factor for both parties. It is possible that the need to give may outweigh the need to receive. Neither party may be able to understand for themselves whether they are choosing or needing. There are many possibilities here that are not objectively reflective of functional need.
In the absence of Dr Meyer-Grieve acknowledging these possibilities and explaining how he had taken them into account, the Tribunal places no weight on his accounts as to Ms Lloyd's functional capacity in the November 2024 report to the extent they are not corroborated by other reliable evidence before the Tribunal.
Further, in so far as November 2024 report from Dr Meyer-Grieve purports to be a report of an expert witness, the Tribunal notes that the duty to provide the Tribunal with impartial assistance on matters relevant to the person's area of knowledge and expertise and to not advocate for a party to a proceeding, has not been met_[114]_. Dr Meyer-Grieve opines that Mr Mate's assessment is "poised to deprive Ms Lloyd of support" and that "chronic depression, unemployment and community withdrawal" are "a seeming certainty" for Ms Lloyd unless either Agency settles the proceeding, or the Tribunal set its decision aside[115]. Such comments cause the Tribunal to conclude the report was written for the purposes of influencing a Tribunal outcome. It is not an expert opinion produced for the Tribunal.
Ms and Mrs Lloyd also put forward emotional evidence including as to the harm that would come to them and their family if the Tribunal did not decide in Ms Lloyd's favour and the harm caused to them by the Tribunal proceedings to date[116]. The Tribunal considers these are an attempt to influence a Tribunal outcome and it has not given weight to them.
Dr Meyer-Grieve at hearing explained that he is mostly concerned with Ms Lloyd's medication. He described his psychology support to Ms Lloyd as "providing scaffolding and problem solving around what would be for most people fairly basic day to day tasks" and constituting a significant part of his work. He told the Tribunal that one in three or four of his treatment sessions are focused on supporting Ms Lloyd though a crisis in her organisational impairments where there are competing demands requiring crisis management. The Tribunal understands and accepts from Ms Lloyd's evidence that she has a regular monthly treatment with Dr Meyer-Grieve with additional appointments scheduled for crisis support when Dr Matthews is unavailable. The Tribunal therefore understands that generally crises management treatments from Dr Meyer-Grieve would occur, on average, approximately every 10 weeks or so.

[73]

As the Tribunal has noted above, Mr Mate is the only expert in the proceeding who is independent, who has conducted a focused assessment of Ms Lloyd's functional capacity and who has assessed Ms Lloyd in her home.
Dr Meyer-Grieve writes in his November 2024 report that based on his knowledge of Ms Lloyd's neurocognitive profile and day-to-day function, Mr Mate's functional assessment outcome "was an over-estimate of function and does not reflect her functional variability or limitations"[117]. The Tribunal explored these views in depth with him at hearing.
Dr Meyer-Grieve clarified at hearing that he respected a lot of the content in Mr Mate's report. He clarified that his principal objection was that Mr Mate was not upfront enough about the limitations inherent in his assessment method. Mr Meyer-Grieve opined that "it is difficult when you are doing a two-hour assessment and asked to offer an expert opinion on a young person's functionality not just for that two hour but for all other times as well... I think from my own point of view I would be a little bit more upfront about the limitations of knowledge and the limitations of drawing inference". He claimed Mr Mate was "very confident in drawing an inference about what the bad days will be like given what the good day is like". Dr Meyer-Grieve went on to critique Mr Mate for failing to undertake observations and not take a collateral history. He noted that a clinician OT working with Ms Lloyd would be interested in the opinions of other clinicians who had been working with that person "for a protracted period of time and observing firsthand aspects of lower function and more significant impairment".
The Tribunal understands the logic of Dr Meyer-Grieve's critique but for the reasons below does not agree with it. The Tribunal notes that his claims that Mr Mate had no collateral history from family and clinicians to support his assessment[118], are unsupported. Mr Mate's briefing papers included the clinical records, expert reports and lay statements that had been prepared at that time and were before the Tribunal. Mr Mate's report confirms he has had regard to them. As further explained below, whilst the expert OT should have regard to all relevant background material in conducting their clinical assessment and reaching conclusions it is ultimately the role of the Tribunal to weight the expert OT's findings in the context of all the evidence before it.
Ms Lloyd contends the Tribunal should give minimal weight to Mr Mate's report. Ms Lloyd stated at hearing Mr Mate made false accusations, assumptions and inferences. She contends the tasks she was given were inadequate to test her functional capacity and that Mr Mate did not detect that she was "masking".
Mrs Lloyd is critical of Mr Mate's report. Her criticisms relate to the issue of masking, and his omission from his report of statements made by her during the assessment. Mrs Lloyd is critical of Mr Mate's methodology in her statement dated 10 October 2024, opining that "a two-hour OT assessment conducted while sitting on a couch talking to Jasmine on a "good day" along with taking photos, cannot adequately reflect the extent of her functional impairments"[119]. She subsequently resiled from her criticisms of the methodology at hearing. Mrs Lloyd is also critical of Mr Mate for failing to take account of the crucial and constant support provided by Mr and Mrs Lloyd as parents[120]. The Tribunal does not give weight to this criticism. Mr Mate reflects in his report that he had considered information from Mrs Lloyd. The Tribunal further notes that an amount of the support given by Mrs and Mr Lloyd is emotional and that it is outside the expertise of an occupational therapist to make findings as to the impact of emotional support on an individual's functional capacity. The expertise of an OT is in assessing function. In so far as Mrs Lloyd submits that Mr Mate spent too much time speaking with Ms Lloyd, the Tribunal notes no written statement from Ms Lloyd was available to him prior to his assessment being conducted. Giving sufficient time to asking her questions was therefore particularly important.
It is helpful to place Mr Mate's report in the wider context of the proceedings.
This proceeding is an application made by Ms Lloyd. The onus is upon Ms Lloyd to satisfy the Tribunal of her case; it is her application. Whilst it is not the Agency's nor the Tribunal's role to make out an applicant's case for them, the Agency must pursuant to section 56 of the ART Act, assist the Tribunal to reach the correct or preferable decision in the proceeding. To assist the Tribunal, and mitigate the financial burden on Ms Lloyd, the Agency used its statutory powers to obtain an independent OT assessment. The Tribunal also made directions enabling Ms Lloyd to file the evidence on which she wished to rely, including a functional capacity assessment conducted upon her instruction should she have wanted to. Without any functional capacity assessment, the Tribunal would have been challenged to assess the claims. The Agency has a responsibility to use its funds in a manner consistent with the objectives of the Act and must strike a balance in enabling of a satisfactory assessment and not incurring excessive publicly funded liabilities. As part of their pre-assessment briefing, the independent OT should be given copies of the documents submitted by the applicant to date. That has occurred. It would be inappropriate for an independent expert to in addition speak to a potential witness of an applicant. This would undermine the independence of their opinion and be unfair to an applicant. These are some of the parameters in which an independent functional capacity assessment needs to take place.
The Tribunal is satisfied the methodology used by Mr Mate, as outlined in his report and further explained by him at hearing is satisfactory, transparent and unbiased. It understands his opinions are the outcome of a point in time, two-hour assessment conducted on a good day for Ms Lloyd and in the morning, when Ms Lloyd's functional capacity is at its highest. Due to the time constraints and fluctuating nature of Ms Lloyd's impairments, The Tribunal observes that the parameters of Mr Mate's assessment are inherently limited. Mr Mate did not seek to downplay those limitations. He acknowledged them at hearing and explained his methodology and his application of deductive reasoning to the types of tasks he selected for practical assessment. The Tribunal does not have a view on whether Mr Mate should have commented specifically on the limitations of a two-hour assessment. It would not have been objectionable if he had, but it was also acceptable that he left that to the Tribunal to form its view on. Tribunal notes Mr Mate's comments about bad days are limited to what Ms Lloyd has reported to him. It has been unable to locate a passage in Mr Mate's report in which he made findings about Ms Lloyd's functional capacity on a bad day. The Tribunal considers these factors in attributing weight to his evidence.

[76]

Based on the accepted impairments and the evidence of Dr Meyer-Grieve and Lindsay-Dawe in particular, the Tribunal accepts that for Ms Lloyd, the effort involved for her in organising her thoughts and words and self-regulating her emotional and behaviour responses consumes more energy than it would for someone without her impairments. The Tribunal does not accept however that it must follow that Mr Mate's assessment is inaccurate. In the Tribunal's opinion, Ms Lloyd is making effort to act at her highest functional capacity in situations that call upon her resolve. This a positive indicator of functional capacity, the ability to determine what is important, to prioritise it and behave with others in a manner responsive of what is at stake. The Tribunal understands that the functional assessment process is inherently taxing, particularly when it forms part of the Tribunal's proceedings. For a 23-year-old with a level of social impairment, to put on her best face and process the emotions once it is all over is to be expected. Mr Mate confirmed this view at hearing. Dr Meyer-Grieve's comments about masking at hearing are also consistent with the Tribunal's view. Dr Meyer-Grieve stated that responding to circumstances in which one is motivated to optimise mental effort is true of everyone; the difference for Ms Lloyd is that she was exhausted from the effort for several days after. The Tribunal accepts that was the case although it agrees with Mr Mate that some exhaustion following the assessment could be expected for anyone.
The Tribunal does not accept Ms Lloyd's claims concerning masking. It does not accept that normal and instinctive effort-making and politeness are symptoms of her permanent impairment and matters over which she has no control. It finds the pathologising by Ms and Mrs Lloyd of Ms Lloyd's thoughts and actions in this way to be an indicator of negative bias as to Ms Lloyd's functional capacity. The Tribunal notes below other indicators of negative bias in the evidence before the Tribunal. The Tribunal notes the work being done By Dr Matthews with Ms Lloyd and reflected in her clinical notes to reframe and re-label understandable feelings that Ms Lloyd pathologises[121].

[85]

The Tribunal notes that an interest in recipe-based cooking and the ability to follow a recipe is not a requirement of functional capacity in any of the activity areas in section 24(1)(c).
The Tribunals note that in her November 2024 statement, Mrs Lloyd frequently claims Ms Lloyd's behaviour is not age-appropriate as compared with her peers or friends. The Tribunal notes that the matters it is confined by law to consider under section 24(1)(c) are whether Ms Lloyd has substantially reduced functional capacity in one or more of six activity areas. That test does not on its face require the Tribunal to reach findings about the age appropriateness of an applicant's behaviour. The Access Guideline does however ask the decision maker to consider in the domain of communication how the applicant communicates compared to others of the same age. The Tribunal would consider a comparison of this nature may also be relevant to assessing social interaction, although the Access Guideline does not specifically raise it. For these areas of assessment, the Tribunal would look to expert opinion. The Tribunal generally considers that it should take great care in extrapolating from subjective opinion from a parent as to how their child's conduct and capacity compares with that of friends and family to reach the required objective findings as to what the applicant can or cannot do.
The Tribunal has given close and thorough consideration to Mrs Lloyd's evidence. It finds that evidence to be exaggerated and disproportionately concerned with the impact of Ms Lloyd's impairments on others and focused on comparing Ms Lloyd's functional capacity to others. It therefore finds Mrs Lloyd's evidence lacks the objectivity and perspective the Tribunal requires for her evidence to be accorded weight on the most critical issue before the Tribunal, being the impact of Ms Lloyd's impairment on herself. To the extent the Tribunal has determined it is safe to give weight to Mrs Lloyd's evidence, it has referenced and discussed such evidence below.

[86]

In the case of Ms Lloyd, the Tribunal is aware that in the hearing environment Ms Lloyd's presentation is complex and that in considering her evidence it must take care to understand her evidence informed by the expert evidence provided and to work actively with self-reflection to avoid interpretation biases of its own. In this respect, the Tribunal is grateful for the evidence of Dr Meyer-Grieve as to Ms Lloyd's relational anxiety, which it details in the section below on social interaction. The Tribunal is also grateful for and impressed by Ms Lloyd's own recognition during the hearing of her negative bias and explanation as to how this influences what she says.
The Tribunal found Ms Lloyd's evidence to be variable. It finds generally her written statements to be exaggerated and her evidence at hearing sometimes candid and self-reflective. In the case of inconsistency between the two, the Tribunal prefers her evidence at hearing.
There were however times in Ms Lloyd's testimony at the hearing where the Tribunal considers she was tailoring her evidence so the Tribunal would view her case in a more favourable light. This was particularly in response to the Agency's questions.
The Tribunal observed Ms Lloyd to be working actively to find the negative in positive functional outcomes when answering questions from the Agency. These questions were about a broad range of events and circumstances such as university group public speaking, completing her high school, winning awards, moving out of the family home and preparing her statements for this proceeding. The Tribunal noted Ms Lloyd to consistently answer these questions in a manner so as to be perceived as dissociated from and not responsible for her capability and success. To the extent Ms Lloyd was cross-examined in relation to Dr Matthews' clinical notes, the Tribunal was not persuaded that the positively expressed reports of Dr Matthews about Ms Lloyd's determination and successes in taking responsibility are an exaggeration by Dr Matthews of Ms Lloyd's functional capacity. Ms Lloyd sought to argue the notes are basic. The Tribunal finds the notes to be clear and detailed. It also observes the notes as whole record many reports of difficulty for Ms Lloyd. That Ms Lloyd sought to argue away almost all contentions put to her by the Agency does impact the reliability of her evidence. The Tribunal further observed that under cross examination, Ms Lloyd's comprehension of the questions was high as was her ability to respond to them.
The Tribunal is in no doubt that in the process of these and similar achievements, Ms Lloyd experienced considerable anxiety and what Dr Meyer-Grieve describes as a sense of dysphoria, or distress, and that these achievements required considerably more effort from Ms Lloyd than they did from others. The Tribunal appreciates that those emotions may contribute to negative bias. However, these feelings as unpleasant as the Tribunal understands they are, are not on their own a reduction in functional capacity. Emotions on their own do not dictate function or whether a task can be done or not. The assessment under section 24(1)(c) is an entirely objective one which considers the outcomes of those emotions and other symptoms of impairments on an applicant's capacity in the six activity areas.
Before assessing in detail whether Ms Lloyd meets the statutory criteria in relation to each of the life activity areas, it is necessary for the Tribunal to address the fluctuating nature of her impairments and seek to reach conclusions about the frequency and intensity of fluctuations.

[92]

The Tribunal accepts the Agency's submission that Dr Matthews' summary is broadly consistent with Miss Lloyd's reflection, in November 2023, of the progress she has made[125].
Ms Lloyd reported to Mr Mate in June 2024 that she has good, average and bad days. She has only one or two good days a month, and two bad days on average each week, or eight to 10 days a month.
Ms Lloyd's evidence at hearing presented a more insightful picture. She stated that she was at her best during Mr Mate's assessment because she is at her best in the morning, when she is not drained from her day and not in sensory overload. The Tribunal understood from this evidence that Ms Lloyd usually has a good morning, but her anxiety and unhappiness mood may increase as the days goes on. This is consistent with Dr Meyer-Grieve's evidence at hearing and his clinical notes. Dr Meyer-Grieve noted in April 2021, for example, that Ms Lloyd reports good focus on schoolwork in the morning and afternoon; unhappiness and anxiety is mostly worse in the afternoon/evening[126]
Ms Lloyd was asked in the hearing if she could estimate how many bad days she had a week. The Tribunal observed her answer to demonstrate self-reflection and insight. Ms Lloyd told the Tribunal that she estimated she had about four bad days a week. Ms Lloyd then added, "the bad things are definitely overshadowing the good little things". She then offered an example, saying that if she had felt good in the morning or had good news in the morning but there were some bad things that happened later in the day, she would look back on the day as being "really bad". She went on to describe a "bad day" as a day where things had just been a struggle, she has just come home from work and she is upset, depressed and down. The Tribunal observes this is markedly different to Ms Lloyds claims in her April 2025 statement. There she states that on a bad day are most of her days; she needs her mum for everything; she needs her mum to stay overnight; she will take an overdose and that she cannot do anything for herself[127].
The Tribunal acknowledges Ms Lloyd's statement dated April 2025 in which she shares her feelings about her job and the emotional overwhelm she experiences while at work. The Tribunal accepts she has negative feelings and cognitive challenges in the workplace. What the Tribunal notes however is that despite this overstimulation and discontent at work, she is able to perform her job to the sufficient satisfaction of her employer that she remains employed there. The Tribunal also notes this is in part due to her capacity to advise her employer of her disability and seek disability related adjustments, learning from and improving her past experiences where she has not done so and implementing the advice of Dr Meyer-Grieve.
Ms Lloyd told the Tribunal that she thinks she has struggled since she has moved out because she is trying to do more on her own and the immediate help is not there. She has felt lonelier and has had more expectations on herself and from her family, and then feeling let down when she cannot do what she set out to half the time. Clinical notes of Dr Matthews however record Ms Lloyd's self-reports of increased resilience[128].
Ms Lloyd said she could have a good week, a good month, or a good few days of the month. It would depend on whether something has triggered her, whether things are going well at work, and she feel motivated and more capable of going than if she is getting bad feedback and overwhelmed. She explained how one little thing going wrong can cause a domino effect of negative thoughts and actions and reactions. There is a very big difference as to whether she had appointments scheduled at that time and whether her parents are busy. When she is feeling very bad, she finds it hard to see that people cannot just come to her side when she wants. She becomes desperate and feels offended her parents are not available to support her. When she is OK, she can be objectively respectful of their independence. She would like to be more independent, but it can be very out of reach sometimes. Mrs Lloyd said that "It can be zero to 100 in such a short period of time that you just never know what day is going to bring what".
The Tribunal asked Ms Lloyd about her attendance at work the week prior to the hearing, Ms Lloyd first replied that she "barely" attended her work shifts last week. She did not want to go because she feels horrible all the time and aspects of her job had been recently changed. She feels under attack, overworked and cannot bear the thought of being in public.
Asked the same question again, Ms Lloyd confirmed she attended all her shifts last week, "with mum and dad trying to get me there" and "trying to get her out of the car".
Asked by the Tribunal to clarify the support she received from her parents in attending work in the week prior to the hearing, Ms and Mrs Lloyd confirmed that assistance had been provided only for one shift. She had called Mrs Lloyd who took an early lunch break to drive Ms Lloyd to work. She did not require assistance to get out of the car.
The Tribunal observes that in response to open-ended exploration in the hearing of Ms Lloyd's days and weeks, that Ms Lloyd identified little in the way of a bad day that could be directly related to reduced functional capacity in any of the six activity areas in section 24(1)(c) of the Act other than self-management. The latter arose out of her evidence of difficulties in sequencing tasks of eating and grooming within a finite timeframe so she could get to work.
The Tribunal observed how catastrophic statements softened and clarified with gentle persistence.
The Tribunal observes that this evidence at hearing directly contradicts the claim of Dr Meyer-Grieve, who states emphatically in November 2024 that if Ms Lloyd is feeling low, she will not go to work at all nor make the necessary communications to manage this[129]. The latter was also not corroborated by Ms Lloyd who told the Tribunal she will send a quick SMS to say she won't be at work. As is noted below, Ms Lloyd told Mr Mate that she missed work approximately once a month because of her impairments and symptoms.
Mrs Lloyd says in her statement dated November 2024 that Ms Lloyd has 10 bad days in which she needs parental care, sleep overs and management of the unit. Mr Lloyd reported to Mr Mate that her parents had been staying overnight with her every couple of weeks but that had reduced more recently as her boyfriend is at her home about 50% of the time[130].The Tribunal does not consider the parental sleepovers to be a reliable indicator regarding functional capacity given it is not possible to separate these out from Ms Lloyd moving out of the family home.
Mrs Lloyd told the Tribunal that Ms Lloyd's limitations in day-to-day activities were not so obvious while she was still living at home. Ms Lloyd would do her own washing from time to time, she would cook with Mrs Lloyd and have chores around the house. Mrs Lloyd would assist with self-care prompting (eating and showering) during a panic attack. Ms Lloyd's difficulties were less obvious and easier to manage while she was living at home. She concluded:

[103]

In her November 2024 statement, Ms Lloyd claims she cannot have proper conversations or easily express herself, especially when tired and anxious. Her mouth cannot keep up with her brain. She enjoys listening to podcasts[136]. Ms Lloyd made other claims under the heading of communication which the Tribunal has considered under the domain of social interaction.
In her April 2025 statement, Ms Lloyd claims she prefers to use voice conversion technology to write as it helps her to order her thoughts and is less tiring than typing[137].
The Tribunal accepts these claims.
At hearing, Ms Lloyd confirmed that she completed her VCE. She confirmed her capabilities at university were mostly assessed by written essays. She also completed public speaking, team-based presentations. She confirmed she won awards at school and university for her assignments.
Ms Lloyd confirmed she was able to communicate with Drs Matthews and Meyer-Grieve in her appointments. She confirmed she can understand what is said to her during the sessions but if she is distressed, she will struggle to take in what Dr Matthews is saying.
Ms Lloyd confirmed that she was able to understand and respond to Mr Mate's questions during his assessment.
In his report, Mr Mate states that Ms Lloyd was able to express herself clearly throughout the assessment[138]. He observed her as able to discuss her symptoms, treatments, and difficulties in various relationship[139]. She confirmed her ability to read, write, use technology and the internet. Mr Mate concludes Ms Lloyd is independent in the activity of communication and no supports are required. He has no OT recommendations in this area[140].
The Tribunal did not observe Ms Lloyd to have difficulties in understanding and responding to the questions asked of her during the hearing. Although her responses were lengthy and she sometimes took a moment to compose her thoughts, she was clear, articulate and responsive. Her written or oral evidence was readily understood by the Tribunal.
Regarding the activity of communication, the Tribunal finds Ms Lloyd's circumstances are not captured by those described in rule 5.8 of the Access Rules. It further finds Ms Lloyd's impairments do not result in substantially reduced functional capacity to undertake the activity of communication.

[110]

In her November 2024 statement[143], Ms Lloyd claims she takes twice as long as others to learn and take in information. She has difficulty understanding verbal instructions in the workplace. She learns best if information and instructions are written down. If the document is long, she learns best by converting text to audio. At work she needs to be shown physically how to fulfill a task, multiple times and with reminders.
Ms Lloyd reported consistent information to Mr Mate[144] that she prefers to learn with visual and written information. She is able to learn new skills but requires extra time. She kept a notebook in her pocket when she first started her job. She has been able to complete Year 12 and university subjects with special considerations, including more time to complete coursework and additional breaks during exams. She has won awards at school. These claims were confirmed by Ms and Mrs Lloyd at hearing. The Tribunal accepts these claims.
Ms Lloyd confirmed at hearing that she was able to complete the essays with special adjustments of more time and able to complete the oral presentations. She said she was tired afterwards. Ms Lloyd confirmed at hearing that she completed her high school VCE with special considerations which allowed her more time to complete the required work. She said she did not have the ADHD diagnosis at that stage.
Ms Lloyd reported at hearing that in her current and previous roles in retail she has had difficulty keeping up with the speed expected by her employer. Clinical notes from Dr Matthews record that Ms Lloyd reported positive feedback for making productivity KPIs[145]. It also finds that she has been provided with disability related adjustments in her two current retail roles.
The Tribunal finds the evidence before it regarding Ms Lloyd's learning to be largely consistent. It accepts that to understand and remember new things, Ms Lloyd requires more time, breaking tasks and information into steps, information repeated, information being presented in multiple mediums (speaking, demonstrating, sequencing, pictorial), rest breaks and check ins[146]. In more complex academic learning in areas, she may require 1:1 assistance[147]. The Tribunal also finds that once information or a task is learned, Ms Lloyd's ability to remember it is at an Average level. The Tribunal does not have material information before it regarding the task of practicing and using new skills. It finds that in the workplace, Ms Lloyd has made her current employers aware of her disability who are largely supportive of it. She has been able to maintain her current positions for several years.
The Tribunal accepts Ms Lloyd has reduced functional capacity in the task of learning and understanding new things but not in remembering new things once learned or in practicing and using new skills. It considers that whilst this leads to some reduction in Ms Lloyd's ability to undertake the activity of learning, there is no one learning task or activity Ms Lloyd forgoes altogether or requires AT, equipment or in person supports to be able to carry out the task as a whole. For this reason, the Tribunal finds Ms Lloyd does not usually require assistance from other people, assistive technology, equipment or home modifications to participate in the activity of learning or to perform tasks or actions required to undertake or participate in the activity of learning.
The Tribunal finds Ms Lloyd's circumstances are not captured by those described in rule 5.8 of the Access Rules. Nor is the Tribunal satisfied that the reduction in Ms Lloyd's functional capacity to undertake the activity of learning is substantial. Accordingly, the Tribunal finds Ms Lloyd's impairments do not result in substantially reduced functional capacity to undertake the activity of learning.

[113]

In Madelaine[148], the AAT expressed the opinion that the Tribunal's assessment in this domain must be principally directed at the personal skills needed for social interaction and only marginally about opportunities to exercise those skills. In the Tribunal's view, this is the correct approach.
In her November 2024 statement[149], Ms Lloyd says that she struggles with maintaining friends and does not have a strong desire or confidence to be so connected to her friends. She leaves it for her friends to contact her first. At work, she feels overwhelmed by the amount of overstimulation and comes home emotionally and physically exhausted.
In her April 2025 statement, Ms Lloyd also spoke of sensory overstimulation at the shopping centre where her work is.
There are several references in the clinical records of Dr Matthews of Ms Lloyd developing and maintaining friendships including by her being proactive in making contact[150]. She held a housewarming party in March 2023 and met her boyfriend at another party in December 2023[151]. The relationship was confirmed at the hearing to be ongoing at the time of the hearing. There is no evidence before the Tribunal that Ms Lloyd has strained relations with her friends and no tangible evidence that Ms Lloyd's impairments negatively impact her relationship with her boyfriend. Dr Meyer-Grieve remarked that any difficulties were reflective of typical relationship issues.
Ms Lloyd has held two jobs for some years in retail. Her employers are large international retailers with stores in Australia. In her oral evidence, Ms Lloyd confirmed that she works alongside others during her shifts and with frequent changes in her managers. She confirmed she talks to customers and colleagues in the workplace. She always tries to do her best to talk with people and there are times when she is not at best.
The clinical records before the Tribunal indicate that Ms Lloyd is a sociable person who likes to be out of the house and not spend too much time on her own[152]. One of her roles is frontline customer service and she reports that she enjoys this role[153]. In her April 2025 statement, Ms Lloyd reports in this role being alternatively overstimulated by customer interaction and the busyness of the centre and bored if there is insufficient of either[154].
At hearing, Mrs Lloyd spoke of one instance of indiscretion in the workplace, when Ms Lloyd sent a social media message criticising her colleagues for not pulling their weight. The Tribunal was told that this workplace was not made aware of Ms Lloyd's disability and advised her that they should have been. The Tribunal otherwise has no tangible evidence of Ms Lloyd having problematic relationships in the workplace because she had allowed her feelings to overwhelm her. There is a passing reference to possible run-ins with colleagues in a 2022 record from Dr Matthews[155] however no further claims were presented to the Tribunal. The Tribunal accepts that occasionally overwhelm causes Ms Lloyd to miss a shift. The Tribunal accepts that this occurs approximately once a month as stated by Mr Mate at hearing. Ms Lloyd told the Tribunal she will text her workplace if she is not coming in. The Tribunal was told at hearing that Ms Lloyd's current employers now know of her disability and that she has been able to negotiate with her managers changes to her responsibilities to accommodate them. She has had one meeting where Mrs Lloyd attended as support and other discussions the Tribunal understands she has conducted on her own. Dr Matthews clinical records reflect such conversations"[156]. Her notes record fluctuations in how Ms Lloyd feels about work[157] , that she receives positive feedback[158] and her ability to recover from what she experienced as negative feedback[159] , to challenge herself to increase her work hours[160] and decrease them as needed.
The Tribunal accepts the Agency's submission that Ms Lloyd's successes in volunteering at her university as a mentor is a positive indicator of her capacity for social interaction[161]. Ms Lloyd also appears to the Tribunal to exhibit skills in social networking.
The Tribunal observed Ms Lloyd to behave appropriately during the hearing. She was attentive and respectful of the Tribunal and the Agency and demonstrated interest, determination and intelligence. There was a point in cross examination where Ms Lloyd told the Tribunal she was feeling angry by the questioning, however to her credit she did not let it overcome her. On a few occasions she spoke over the top of Mrs Lloyd and later in the hearing appeared emotional and turned to Mrs Lloyd for comfort. She was not observed to become overwhelmed.
Mrs Lloyd remarked at the hearing that Ms Lloyd's difficult behaviours would not come out at school but at home. Mrs Lloyd told the Tribunal that after the first hearing day there was a family dinner, Ms Lloyd was overstimulated and talking too much; an argument ensued resulting in her kicking the dog gate and Mr Lloyd needing to take her home. Ms Lloyd said at hearing that on a very bad day she may withdraw from her parents and boyfriend and not return calls or texts. She may do the opposite if she wants help and call and text incessantly.
The Tribunal accepts on all the evidence before it that Ms Lloyd has reduced functional capacity in her relationships with the members of her nuclear family by reason of her impairments. It does so on the understanding that the very nature of those familial relationships both contribute to and suffer from her relational anxiety, as the concept was explained by Dr Meyer-Grieve at hearing:

[116]

The Tribunal accepts Dr Meyer-Grieve's expert opinion that Ms Lloyd's relational anxiety has the potential to impair any number of individual and group relationships. However, considering the evidence holistically it demonstrates that Ms Lloyd has the capacity to develop and sustain relationships with friends, employers and interact effectively with the community despite the underlying impairment. She takes mature action to inform her employers of her disability and to raise new needs as they arise and when she has the confidence to do so, which in turn builds the relationship. She has found secure support in a boyfriend, maintains five to six friends with whom she is in regular contact through social media[162] and is closer to those she has had since she was young who she feels understand her needs and symptoms better, which suggests the capacity to choose and keep her friends wisely. She may avoid an overstimulating social environment and on a few occasions has needed to remove herself suddenly[163]. The Tribunal accepts that on some occasions she is supported by a parent to leave that environment and get home.
The Tribunal accepts Ms Lloyd has a reduction in her capacity for social interaction. However, there is no one social interaction task she forgoes altogether or requires AT, equipment or in person supports to be able to carry out the task as a whole. The Tribunal considers that Ms Lloyd experiences impairment in only discreet components of the range of tasks or actions that comprise the activity of social interaction. For this reason, the Tribunal finds she does not usually require assistance from other people, assistive technology, equipment or home modifications to participate in the activity of social interaction or to perform tasks or actions required to undertake or participate in the activity.
The Tribunal finds Ms Lloyd's circumstances are not captured by those described in rule 5.8 of the Access Rules. Nor is the Tribunal satisfied that the reduction in Ms Lloyd's functional capacity to undertake the activity of social interaction is substantial. Accordingly, the Tribunal finds Ms Lloyd's impairments do not result in substantially reduced functional capacity to undertake the activity of social interaction.

[124]

In the Tribunal's view, the claims by Ms Lloyd in this area principally relate to the cognitive tasks of self-management, her capacity to manage her day-to-day life and keep on top of these tasks rather than her ability physically carry them out to a satisfactory standard consistent with societal norms. The Tribunal follows the approach of the Tribunal in the recent decision of Burrows and considers Ms Lloyd's claims of impaired cognitive ability to conduct self-care as part of self-management[166]. It notes the position in Burrows that the tasks of washing and housework do not come within the activity area of self-care[167] and adopts that position in so far as they constitute more than maintaining essential hygiene.
The evidence before the Tribunal indicates that Ms Lloyd has awareness of what socially accepted norms are in all the tasks in the activity area of self-care. She also has the intellectual and physical capability to achieve these standards. The Tribunal relies on the findings by Mr Mate that Ms Lloyd is independent with toileting, feminine hygiene, washing hands, bathing and drying herself, washing and drying her hair, brushing her hair, cutting her nails, feeding herself and taking her medication[168].
Regarding Ms Lloyd's claims about eating and cooking, the Tribunal accepts that Ms Lloyd's impairments lead to inconsistency and apathy in preparing for meals, including shopping, cooking as well as eating. This is confirmed in Mr Mate's report and the Tribunal accepts Ms Lloyd may go a day or half a day without eating[169]. The Tribunal accepts, based on Dr Meyer-Grieve's evidence of relational anxiety that not being organised with eating causes Ms Lloyd to be self-critical and upon that, further anxiety. Equally, in the Tribunal's view, care should be taken not to pathologise Ms Lloyd's entire relationship with food. The Tribunal accepts Ms Lloyd's evidence in her April 2025 statement that when she is feeling good and productive, she will choose not to eat because she is enjoying the moments of focus and does not want to break her concentration and sense of achievement. She has left the family home in difficult circumstances, has no particular interest in cooking, and meals when she is on her own have become eating rather than social connection which is the essence of family meals. Doctor Matthews also records that when excited and distracted, Ms Lloyd may eat late or skip a meal. Dr Matthews clinical notes record that Ms Lloyd can cook and purchase groceries on her own though she does so irregularly[170].
Mrs Lloyd told the Tribunal that Ms Lloyd can cook, that she regularly orders Uber Eats and that she and Mr Lloyd may cook something and drop a meal over and perhaps eat with her. Ms Lloyd reports in her April 2025 statement that she sometimes eats at the shopping centre where she works before starting her shift[171]
The Tribunal does not accept as credible Ms Lloyd's claim at hearing that she will go without eating for days or in her April 2025 that she cannot cook and cannot eat food prepared for her by her family until she feels unwell. The Tribunal notes that across the records of Dr Matthews there is little concern that Ms Lloyd may not be keeping up with self-care tasks except in the broader sense of keeping a balance between responsibilities for others and looking after oneself. The Tribunal has no medical records to suggest Ms Lloyd has an eating disorder or nutritional deficiency. In a clinical note from April 2021, Dr Matthews observes that the ADHD diagnosis is making Ms Lloyd analyse and pathologise things and that she is still after the "quick fix"[172]. Dr Matthews notes specifically that Ms Lloyd had said she was worried she was forgetting to put on deodorant. Dr Matthews writes:

[137]

Ms Lloyd submits she usually requires assistance in the form of guidance, supervision or prompting from her family and her treating practitioners to perform the above tasks. As self-management concerns only the cognitive ability to manage your life, the Tribunal considers there are no relevant claims for physical assistance before it. The Tribunal also considers that there is no evidence that Ms Lloyd requires assistance to participate in the activity of self-management. She has sufficient motivation to participate in all of them.
The Tribunal's view is that this domain does not refer to difficulties with managing assigned tasks in the workplace. It concerns personal self-management, that is, how a person manages their personal life.
At a high level, the Tribunal finds Ms Lloyd to be personally organised. Ms Lloyd presented to the Tribunal as having a structured life. She explained at hearing that an ordinary week involves working four part-time shifts in retail, arranging something social and spending time with her boyfriend. She is described at various points in the evidence by Mrs Lloyd as rigid and describes herself as disliking change. There is no information before the Tribunal that Ms Lloyd does not manage the organisation of her current employment herself. Similarly, there is no information that Ms Lloyd did not manage her university studies when she was undertaking them. Mr Mate told the Tribunal he had formed the opinion Ms Lloyd had the capacity to self-manage her employment. Despite periods of difficulty with housework, as outlined below, the Tribunal also finds Ms Lloyd to be personally organised in the home environment. That Mrs Lloyd manages the organisation of a significant legal activity such as these proceedings is not unusual.
Mr Mate said at hearing that he looks as part of his assessment of self-management for signs of real disorganisation in the home, such as disorganised documents. Mr Mate reported[177] that Ms Lloyd's home was observed to be tidy, without significant clutter or obvious hygiene issues and her kitchen was clean and well-maintained. Ms Lloyd reported to Mr Mate that she likes to keep her home clean and tidy, can experience 'OCD' traits, and cleans regularly. Mr Mate said that in Ms Lloyd's case he was relying on her self-reports about the strategies she used as reminders and prompts. He concluded she would benefit from additional OT supports.
The claims made by Ms Lloyd regarding difficulties in personal organisation relate primarily to laundry, keeping tidy, grocery shopping and meal planning. The Tribunal accepts the evidence of Ms and Mrs Lloyd that Ms Lloyd performs all domestic duties. She has difficulty performing them consistently, however. Mrs Lloyd will spend a day with Ms Lloyd every three to four weeks to assist her with laundry[178]. Ms Lloyd is recorded in the notes of Dr Matthews as saying that she has lots on the go, tends not to finish anything and has things in piles[179]. She reiterated at hearing that she had piles of clothes at the end of the bed, uses 'organised piles' and her habit is to relocate the piles rather than resolve them
Photos in Mr Mate's report corroborate the above claims. The unit is clean and tidy in common areas. The bedroom has what appear to be organised piles of clothing. The Tribunal does not observe other items being piled up, besides clothes. Ms Lloyd reported to the Tribunal, and it accepts, that she did a quick tidy up before Mr Mate arrived.
Ms Lloyd explained that on a workday she uses timers to keep her on task. She might do some cleaning before her shift. She may or may not have remembered to eat or wash her work uniform. Her objective is to get dressed, eat and then walk to work or take the train to arrive at her shift on time. She can get confused if there are unexpected changes to the train timetable. She may turn up an hour early by mistake. She may take an Uber if she is running late. The Tribunal understood that in the week before the hearing she ran late on one day such that she needed to call Mrs Lloyd to pick her up and drive her to work to make her shift on time.
Ms Lloyd reported to Mr Mate that she uses electronic reminders, lists and notepads to support her in remembering important details and to attend appointments. Dr Matthews notes that Ms Lloyd uses lists to help her with planning, decision making and memory recall.
Dr Meyer-Grieve at hearing opined that Ms Lloyd's difficulties are in the tasks of personal organisation, planning and problem solving, particularly when several ideas and bundles of information need to be held in the mind simultaneously. He reported that she has a lot of lists of things that are causing stress or overwhelm rather than a list of tasks to be sequentially completed. He will sometimes work with her to break an overwhelming task into sub-tasks and order them sequentially. He understood that her parents are often assisting with this as well. The Tribunal has noted above that approximately every 10 weeks or so, on average, his session with Ms Lloyd will be focused on helping her to resolve an 'organisational crisis' which arises from two to three competing personal demands converging. These might be something at work, a family or relationship demand or an administrative task
The Tribunal accepts Dr Meyer-Grieve's opinions and understand them to be consistent with Mr Mate's conclusion[180] that Ms Lloyd's capacity for problem-solving and planning is impaired. The Tribunal would only add that the deficits are best characterised as relating to organisation and problem solving. Ms Lloyd appears to the Tribunal to be able to make plans in her day-to-day life, including in partnership with others. Mr Mate continues that Ms Lloyd is generally able to make decisions if the information is presented to her but can experience anxiety or overwhelm and phones her parents for support. This is over and above the daily contact by SMS and phone which he attributes to habit and loneliness. Mrs Lloyd gave similar evidence to the Tribunal at hearing, stating she also seeks out contact if she not heard from Ms Lloyd for a day. The Tribunal notes that they also use the Life360 app to monitor each other's location.
The Tribunal understands this cognitive picture of self-management deficits and abilities if reflective of Ms Lloyd's permanent impairments supported by her intellect.
The Tribunal accepts Mr Mate's conclusion that Ms Lloyd is independent in most day-to-day decisions but requires emotional support and direction from her parents when making complex life decisions due to her age, lack of confidence, relatively new to living out of home and her anxiety and ADHD symptoms[181].
The Tribunal accepts that Ms Lloyd manages her medication through the Medadvisor App, which enables management of dosage reminders, scripts and enables pre-ordering and delivery of medication. She sets reminder alarms. She manages her appointments with SMS reminders from the surgery, a regular schedule and seeking out ad hoc additional appointments as needed. Clinical records demonstrate Ms Lloyd does not forget or miss her appointments. She writes notes for her medical appointments beforehand so she does not forget. Ms Lloyd stated at hearing that she is able to talk to her workplaces about her diagnoses, needs and symptom flare ups. There are times she would like to be able to tell them more but the frequency of changes in managers makes this difficult
Dr Meyer-Grieve claims in his November 2024 report that Ms Lloyd unable to manage her financial obligations due to impulsivity[182]. The Tribunal does not accept this claim.
Ms Lloyd reported to Mr Mate that she budgets, manages her finances, can pay bills and invoices[183].
Mrs Lloyd gave evidence at hearing that she and Mr Lloyd needed to cover the weekly rent on five occasions in the last year. Ms Lloyd sometimes takes Ubers and once bought an $800 tent when she does not go camping. No further details were provided as to what led to the purchase of the tent. In the Tribunal's opinion, for a 24-year-old to occasionally buy something they can't afford, they think they want but are unlikely to make good use of is normal behaviour.
The task area concerns the cognitive ability to manage finances. It does not require financial independence. There is evidence in the proceeding as to expectations of financial on Ms independence and the consequential exacerbation of her impairments, in line with Dr Meyer-Grieve's opinions on Ms Lloyd's relational anxiety. The following statement from Mrs Lloyd's November 2024 statement illustrates:

[161]

In his November 2023, Dr Meyer-Grieve opines that further gains in Ms Lloyd's functional capacity will be made through non-pharmacological interventions that scaffold her impairments, including vocational supports, supports with independent living, psychology and occupational therapy[189].
Mr Mate similarly recommends OT and psychology supports but not support worker supports.
The earliest expert assessment report recommending supports for Ms Lloyd is Dr Lindsay-Dawe's neuropsychological report based on her assessment in January 2021[190]. The Tribunal notes this was over four years prior to the hearing. Dr Lindsay-Dawe makes seven recommendations, including a psychiatry review, continued psychological support, supporting sleep, investigating university supports, practical steps to support working memory, and seven strategies to support impulsivity and cognitive flexibility[191].
The Respondent submits the Tribunal should place weight on the absence of a recommendation from Dr Lindsay-Dawe for any formal supports such an occupational therapist (OT) or disability support worker[192]. The Tribunal considers the recommendations in the report need to be understood in the context in which the report was written.
Dr Lindsay-Dawe states that the reason for referral was to investigate further "longstanding wonderings as to whether an underlying neurodevelopmental disorder is contributing to some of the difficulties Jasmine experiences. A review assessment of Jasmine's intellectual and broader cognitive skills was requested to investigate this further as well as to inform and support Jasmine into adulthood"[193]. The Tribunal accepts therefore that a function of the report was to provide recommendations for support.
The Tribunal notes that Ms Lloyd was living at home and studying at university at the time Dr Lindsay-Dawe made her recommendations. Given Ms Lloyd's circumstances have changed, some of these recommendations are now obsolete. It notes that the psychiatric review has been completed and issues with Ms Lloyd's sleep have otherwise not substantially arisen on the evidence. Looking at the language of the report and the context in which it was written, the Tribunal cannot dismiss the possibility that there was a focus in the recommendations on, as Dr Lindsay Dawe calls them, informal "strategies" that can be undertaken by Ms Lloyd with the support of her family, because that is what she was asked to provide. The Tribunal further notes that some of strategies for "Supporting Impulsivity and Cognitive Flexibility" are consistent with the role of an OT and a support worker carefully selected to assist with self-management. Finally, on the matter of Dr Lindsay-Dawe's recommendations, the Tribunal notes she does recommend ongoing psychological support. This in the Tribunal's view is a formal support. Whether it meets the requirements of section 25 is a separate issue and is discussed further below.
Accordingly, the Tribunal proceeds on the basis that the early intervention supports under consideration are occupational therapy, support worker hours and psychology supports.

[162]

The opinions before the Tribunal as to the merits of and desire for support worker supports, are contradictory.
Dr Meyer-Grieve suggested in his oral evidence that Ms Lloyd would benefit from a support worker for a few hours in the morning on her scheduled workdays. His opinion was given in the context of section 24 claims, however the Tribunal considers out of the abundance of caution that the claim has been put in relation to section 25 as well.
There is no evidence from Dr Matthews that Ms Lloyd requires or would benefit from a support worker. Dr Matthews records indicate she is working with Ms Lloyd on exploring the family conflict between dependence and independence and on Ms Lloyd taking more responsibility for herself. Regarding the latter behaviour and attitude in particular the clinical evidence does not persuasively link it to Ms Lloyd's impairments.
Ms Lloyd's evidence indicates she is ambivalent about support worker supports. She spoke at hearing of her internal conflict about wanting supports and wanting to be seen as independent.
The Tribunal must consider the recommendation of a support worker as an early intervention support in light of the objects of the Act. The principal object in this context is to support the independence, social and economic participation of people with disability (section 3(1)(c)) having regard to the need to ensure the financial sustainability of the scheme (section 3(3)(b)). In light of these objects, it is the Tribunal's view that early intervention supports should be designed to grow Ms Lloyd's capacity to manage her impairments independently and that a support worker would be considered when other strategies have been explored and their outcomes assessed.
The Tribunal notes its findings above that the impact of Ms Lloyd's impairments is largely on her functional capacity for self-management. Despite Dr Myer-Grieve's opinion that this would reduce the cognitive load on Ms Lloyd on her workdays, and potentially mitigate the impact of Ms Lloyd's executive dysfunction on her capacity for self-management, there is no supporting evidence as to how this strategy would reduce her future needs for supports. The Tribunal has found Ms Lloyd to have only minor impairment in the activity of self-care. Further, to provide support worker supports at this time is contradicted by Mr Mate's opinion, which the Tribunal accepts, that occupational therapy supports complemented by continuing psychology and psychiatry treatments are sufficient to significantly improve her independence in this domain.
Dr Meyer-Grieve's opinion is that Ms Lloyd is in a childlike position of dependency with her parents[194]. There is no evidence before Tribunal that the provision of a support worker would positively contribute increased independency for Ms Lloyd from her parents or otherwise achieve more that transfer the dependency relationship to the support worker. At hearing, Ms Lloyd's evidence similarly evidenced a childlike dependency on her psychology and psychiatry supports. Catastrophising and themes of hopelessness and helplessness are recorded in Dr Matthew clinical notes[195]. The following passage in her April 2025 statement about her struggles at work illustrates Ms Lloyd also has a childlike view of the role of a support worker.
I have multiple mental hurdles I face at my job at ... It's making the job very hard to stick with and ending up in my absences and lack of motivation there being really not good. Any assistance of a support worker on explaining my difficulties in a clearer way than I would, would benefit me so much. Just having someone to remind them that unfortunately I'm not like our best speediest picker in online, I'm nowhere near most of the time, as of my neurological impairments. The extra motivation and somewhat kick out of bed in the morning to get there and do the job would be so, so beneficial. Just helping me stay accountable to show up to work and helping me get the help I need so I can maybe actually enjoy it would be so good. ... I need someone who can better explain my weaknesses and get them to get off my back and actually help me to do better at my job ... Anything would be so much better than having to be stuck there part time to pay my bills when I'm so unhappy, stressed and misunderstood.
On all the evidence, the Tribunal concludes that the provision of support worker supports is at risk of increasing Ms Lloyd's dependence. It is not likely to benefit her by reducing her future needs for support in relation to her disability. The Tribunal concludes that support worker supports do not meet the requirements of section 25(1)(b).
Psychology supports
In their May 2023 report, Drs Matthews and Meyer-Grieve opine that CBT has limited success for Ms Lloyd, that Mindfulness Based Cognitive Therapy provided no appreciable benefit and Psychoeducation has resulted in short lived improvements that have not improved functional capacity. The Tribunal notes this conclusion was reached after 8 years of psychology treatment. The Tribunal therefore understand their opinion to be that psychology supports will need to be ongoing. They are not of an early intervention nature.
The Tribunal notes it has no new evidence from Dr Matthews to contradict or develop this opinion.
It follows that psychology supports are not early intervention supports within the meaning of section 25(1)(b).
Occupational therapy supports
Mr Mate in is report recommends OT intervention to build Ms Lloyd's capacity for self-care tasks and to support the development of life skills and build her capacity for self-management[196]. He recommends that OT support be introduced that are designed to develop "independent living goals and building Ms Lloyd's capacity for healthy routines and self care using techniques such as pacing, forward and backward chaining, repetition and grading". He notes that Ms Lloyd has not had OT intervention or assessment as an adult focusing on life skills or developing a routine with self-care tasks. Consistent with Mrs Lloyd's evidence at hearing, he notes that Ms Lloyd received OT supports as child directed to different functional issues. He concludes:
I consider it likely that with appropriate intervention from a suitably qualified occupational therapist experience with working with people with executive dysfunction, Ms Lloyd will build her capacity for self-care tasks and self management tasks, , avoid relying on support worker assistance, increase her independence and functional capacity and reduce her reliance on support over time
Mr Mate further opines that early intervention OT supports are likely to reduce the future need for supports by positively satisfying all four criteria in section 25(1)(c) of the Act
Mr Mate emphatically confirmed this recommendation at hearing. He sated that an occupational therapist will work to develop a routine and use pacing techniques to spread the task and build Ms Lloyd's capacity to spread the task to ty to reduce some of the fatigue. They would use compensatory approaches and strategies to manage the symptoms of the impairments. In his opinion he would expect a lasting level of improvement in her impairment by enabling Ms Lloyd to perform self-management and self-care tasks with increased independence or increased consistency and achieve a long-term reduction in fatigue.
Dr Meyer-Grieve stated at hearing that OT interventions to build skills and support their implementation could be helpful. He questioned however that practical application of skills will have a limited opportunity to be galvanised.
The Tribunal considers that Dr Meyer-Grieve's opinion has to be seen in the context of his strong advocacy position for lifetime supports. In that context, the Tribunal considers it unreliable.
The Tribunal has given considerable weight to Mr Mate's report in its assessment of the claims against section 24 of the Act for all the reasons previously given. It sees no reason to question his opinion in relation to section 25.
The Agency submits that the Tribunal should reject his opinion because OT supports would not improve the underlying impairment. That is not the test, however. Section 25(1)(b) requires the Tribunal to consider whether early intervention support are likely to benefit the person by reducing their future needs for supports in relation to their disability by way of one or more of the four criteria in section 25(1)(c). These criteria all go to addressing the impact of the impairment upon functional capacity or the person's functional capacity directly.
The Tribunal is satisfied that occupational therapy supports as outlined by Mr Mate in his report in the activity areas of self-management and self-care, and noting that the Tribunal has classified some of the daily living tasks he is concerned with as cognitive tasks of self-management are likely to benefit Ms Lloyd by reducing her future need for supports in each of the ways stated in sections 25(1)(c)(i) to (iii) of the Act. The Tribunal is not satisfied that the criteria in sub-section 25(1)(c)(iv) are met given Mrs Lloyd's negative attitudes expressed about occupational therapy in the hearing.
The Tribunal is further satisfied that the early intervention supports of OT are most appropriately funded or provided through the NDIS and not 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.
It follows from there that Ms Lloyd meets the early intervention requirements in section 25 of the Act in relation to her neurological and psychosocial impairments.
As the Tribunal has concluded Ms Lloyd meets the requirements for access to the NDIS, it must set aside the decision under review.

Lloyd and National Disability Insurance Agency (NDIS) [2025] ARTA 2064 (9 October 2025)

At a glance

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Decision date

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Judgment (186 paragraphs)

Lloyd and National Disability Insurance Agency (NDIS) [2025] ARTA 2064 (9 October 2025)

Legislation Cited (8)

Cases Cited (1)