austlii:cth/ARTA/2025/1217
General information, not legal advice.
ARTA
2025-08-04
Senior Member P
Original judgment source is linked above.
I would like to see my children more and have precious moments with my children > > I would like to maintain my personal hygiene, my health and my home clean > > I would like to strengthen my muscles and increase my functional level especially on my left side so that I become more independent > > > >
3 Objects of the Act > > (1) The objects of this Act are to: > > ...
(d) provide reasonable and necessary supports ... for participants in the National Disability Insurance Scheme;
(e) enable people with disability to exercise choice and control in the pursuit of their goals and in the planning and delivery of their supports; ...
4 General principles guiding actions under this Act
...
(4) People with disability should be supported to exercise choice, including in relation to taking reasonable risks, in the pursuit of their goals and the planning and delivery of their supports.
(5) People with disability should be supported to receive reasonable and necessary supports ...
...
(8) People with disability have the same right as other members of Australian society to be able to determine their own best interests, including the right to exercise choice and control, and to engage as equal partners in decisions that will affect their lives.
...
(11) Reasonable and necessary supports for people with disability should:
(a) support people with disability to pursue their goals and maximise their independence; and
(b) support people with disability to live independently and to be included in the community as fully participating citizens; and
(c) develop and support the capacity of people with disability to undertake activities that enable them to participate in the community and in employment.
...
It is the intention of the Parliament that, if this Act requires or permits an act or thing to be done by or in relation to a person with disability by another person, the act or thing is to be done, so far as practicable, in accordance with both the general principles set out in section 4 and the following principles: > > ...
(b) people with disability should be encouraged to engage in the life of the community;
...
(d) the cultural and linguistic circumstances ... of people with disability should be taken into account;
(e) the supportive relationships, friendships and connections with others of people with disability should be recognised,
...
17A Principles relating to the participation of people with disability
(1A) In performing the CEO's functions and exercising the CEO's powers under this Chapter, the CEO must have regard to the principles in this section.
(1) People with disability are assumed, so far as is reasonable in the circumstances, to have capacity to determine their own best interests and make decisions that affect their own lives.
(2) People with disability will be supported in their dealings and communications with the Agency so their capacity to exercise choice and control is maximised.
(3) The National Disability Insurance Scheme is to:
(a) respect the interests of people with disability in exercising choice and control about matters that affect them; and
(b) enable people with disability to make decisions that will affect their lives; and
(c) support people with disability to participate in, and contribute to, social and economic life.
...
31 Principles relating to plans
The preparation, variation, reassessment and replacement of a participant's plan, and the management of funding for supports under a participant's plan, should so far as reasonably practicable:
(a) be individualised; and
(b) be directed by the participant; and
(c) where relevant, consider and respect the role of family, carers and other persons who are significant in the life of the participant; and
(ca) where relevant, recognise and respect the relationship between the participant and their families and carers.
...
(g) be underpinned by the right of the participant to exercise control over his or her own life; and
(h) advance the inclusion and participation in the community of the participant with the aim of achieving his or her individual aspirations; and
(i) maximise the choice and independence of the participant; and
(j) facilitate tailored and flexible responses to the individual goals and needs of the participant.
...
34 Reasonable and necessary supports > > (1) For the purposes of specifying, in a statement of participant supports, the general supports that will be provided, and the reasonable and necessary supports that will be funded, the CEO must be satisfied of all of the following in relation to the funding or provision of each such support.
(aa) the support is necessary to address needs of the participant arising from an impairment in relation to which the participant meets the disability requirements (see s 24) or the early intervention requirements (see section 25);
(a) the support will assist the participant to pursue the goals, objectives and aspirations included in the participant's statement of goals and aspirations;
(b) the support will assist the participant to undertake activities, so as to facilitate the participant's social and economic participation;
(c) the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support;
(d) the support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice;
(e) the funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide;
(f) the support is an NDIS support for the participant.
Note: For the purposes of paragraph (aa):
(a) the time at which the disability requirements or the early intervention requirements need to be met is the time the CEO decides to approve the statement of participant supports; and
(b) a participant's disability support needs arising from an impairment in relation to which the participant meets the disability requirements or early intervention requirements may be affected by a variety of factors, including environmental factors or the impact of another impairment in relation to which the participant does not meet either of those requirements.
(2) The National Disability Insurance Scheme rules may prescribe methods or criteria to be applied, or matters to which the CEO is to have regard, in deciding whether or not he or she is satisfied as mentioned in any of paragraphs (1)(aa) to (f).
34. Part 3 of the National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Cth) (the Supports for Participants Rules) contains Rules for assessing proposed supports, including, relevantly, against the 'value for money' criterion in s 34(1)(c), and the 'effective and beneficial and current good practice' criteria in s 34(1)(d) of the Act.
Value for money > > 3.1 In deciding whether the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support, the CEO is to consider the following matters:
(a) whether there are comparable supports which would achieve the same outcome at a substantially lower cost;
(b) whether there is evidence that the support will substantially improve the life stage outcomes for, and be of long-term benefit to, the participant;
(c) whether funding or provision of the support is likely to reduce the cost of the funding of supports for the participant in the long term (for example, some early intervention supports may be value for money given their potential to avoid or delay reliance on more costly supports);
(d) for supports that involve the provision of equipment or modifications:
(i) the comparative cost of purchasing or leasing the equipment or modifications; and
(ii) whether there are any expected changes in technology or the participant's circumstances in the short-term that would make it inappropriate to fund the equipment or modifications;
(e) Whether the cost of the support is comparable to the cost of supports of the same kind that are provided in the area in which the participant resides;
(f) whether the support will increase the participant's independence and reduce the participant's need for other kinds of supports (for example, some home modifications may reduce a participant's need for home care).
Effective and beneficial and current good practice
3.2 In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to consider the available evidence of the effectiveness of the support for others in like circumstances. That evidence may include:
(a) published and referred literature and any consensus of expert opinion;
(b) the lived experience of the participant or their carers; or
(c) anything the Agency has learnt through delivery of the NDIS.
3.3 In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to take into account, and if necessary seek, expert opinion.
24 Disability requirements > > (1) A person meets the disability requirements if:
(a) the person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or the person has one or more impairments to which a psychosocial disability is attributable; and
(b) the impairment or impairments are, or are likely to be, permanent; and
(c) the impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities:
(i) communication;
(ii) social interaction;
(iii) learning;
(iv) mobility;
(v) self-care;
(vi) self-management; and
(d) the impairments or impairments affect the person's capacity for social and economic participation; and
(e) the person is likely to require NDIS supports under the National Disability Insurance Scheme for the person's lifetime.
(2) For the purposes of subsection (1), an impairment or impairments that vary in intensity may be permanent, and the person is likely to require NDIS supports under the National Disability Insurance Scheme for their lifetime, despite the variation.
(3) For the purposes of subsection (1), an impairment or impairments that are episodic or fluctuating may be taken to be permanent, and the person may be taken to be likely to require NDIS supports for the person's lifetime, despite the episodic or fluctuating nature of the impairments.
...
When is an impairment permanent or likely to be permanent for the disability requirements? > > 5.4 An impairment is, or is likely to be, permanent ... only if there are no known available and appropriate evidence-based clinical, medical or other treatments that would be likely to remedy the impairment. > > 5.5 An impairment may be permanent notwithstanding that the severity of its impact on the functional capacity of the person may fluctuate or there are prospects that the severity of the impact of the impairment on the person's functional capacity, including their psychosocial functioning, may improve. > > 5.6 An impairment may require medical treatment and review before a determination can be made about whether the impairment is permanent or likely to be permanent. The impairment is, or is likely to be, permanent only if the impairment does not require further medical treatment or review in order for its permanency or likely permanency to be demonstrated (even though the impairment may continue to be treated and reviewed after this has been demonstrated. > > 5.7 If an impairment is of a degenerative nature, the impairment is, or is likely to be, permanent if medical or other treatment would not, or would be unlikely to, improve the condition.
When does an impairment result in substantially reduced functional capacity to undertake relevant activities > > 5.8 An impairment results in substantially reduced functional capacity of a person to undertake one or more of the relevant activities - communication, social interaction, learning, mobility, self-care or self-management ... - if its result is that:
(a) the person is unable to participate effectively or completely in the activity, or to perform tasks or actions required to undertake or participate effectively or completely in the activity, without assistive technology, equipment (other than commonly used items such as glasses) or home modifications; or
(b) the person usually requires assistance (including physical assistance, guidance, supervision or prompting) from other people to participant in the activity or to perform tasks or actions required to undertake or participate in the activity; or
(c) the person is unable to participate in the activity or to perform tasks or actions required to undertake or participate in the activity, even with assistive technology, equipment, home modifications or assistance from another person.
(5) In deciding whether or not to approve a statement of participant supports under subsection (2), the CEO must:
(a) have regard to the participant's statement of goals and aspirations; and
(b) have regard to relevant assessments conducted in relation to the participant; and
(c) be satisfied as mentioned in section 34 in relation to the reasonable and necessary supports that will be funded and the general supports that will be provided; and
(d) apply the National Disability Insurance Scheme rules (if any) made for the purposes of s 35; and
(e) have regard to the principle that a participant should manage his or her plan to the extent that he or she wishes to do so; and
(f) have regard to the operation and effectiveness of any previous plans of the participant; and
(g) have regard to whether section 46 (acquittal of NDIS amounts) was complied with in relation to any previous plan for the participant.
(a) Is the support that remains in dispute a NDIS Support as defined?
If the answer to this question is "no", the support cannot be considered for approval in the Applicant's SoPS because it cannot meet the requirement of s 34(1)(f).
If the answer to (a) is "yes" with respect to the support that remains in dispute, then that support can be considered for approval in the Applicant's SoPS if it is a support that is necessary to address needs of the Applicant that arise from an impairment in relation to which he meets the disability requirement. Therefore:
(b) What are the Applicant's permanent impairments that result in substantially reduced functional capacity to undertake any of the activities of communication, social interaction, learning, mobility, self-care and self-management, and which affect his capacity for social or economic participation?
(c) Does the support in dispute meet the needs of the Applicant arising from an impairment in relation to which he meets these disability requirements?
If the support in dispute does not meet the needs of the Applicant arising from an impairment in relation to which he meets the disability requirements then it cannot be considered for inclusion his SoPS because it cannot meet the requirements of s 34(1)(aa).
(d) If the answer to (c) is "yes" then ask whether the support in dispute meets the requirements of s 34(1)(a), (b), (c), (d) and (e) and Rule 7 of the Miscellaneous Provisions Rules.
Do the supports in dispute meet the needs of the Applicant arising from an impairment in relation to which he meets the disability requirement?
*_ He is motivated to maintain a balanced healthy diet based on culturally appropriate meals,[45]
*_ He is unable to safely mobilise without assistive equipment due to imbalance and muscle weakness. He uses a 4-wheel walker (4ww) independently to mobilise safely within and outside his home where possible. The 4ww does not fit in his toilet or shower at home however, due to limited circulation space. He can also mobilise independently over a short range by holding onto fixtures.[48] He also uses a single pronged walking stick in his right hand to mobilise outside his home.[49]
Transport to accompany ... to social activities within his community (café, shops, beach, movies etc)
Transport ... to family-based activities (ie dinner, lunch, family events) in which he is surrounded by his family
... strongly values social connection and integration. He enjoys spending time with others. He enjoys going out to a social activity each day. ... dislikes being alone, as he tends to think a lot about his children.
He requires physical supervision to exit his home (stairs) and support to set up his 4ww and unload from the car. He also requires transport to social activities outside his area.
Requires transport assistance. He does not appear to be able to drive completely unaccompanied. He requires physical supervision to exit his home (stairs) and support to set up his 4ww and unload from the car.
I have not provided accompaniment support ... when at family activities with his siblings in their home.
I cannot see a clinically justifiable reason as to why he would require accompaniment support, noting that his family could provide him with any informal support during these family-based engagements (i.e mobility supervision/fetch & gather support). In my recommendations of hours, I have considered the fact that his family live locally (within a 15-minute drive)
9 hours per week.
That is an allowance for 3 x 3 hour outings each week
3 hours per week
That is an allowance for approx. 4 x family based social outings per week
Support worker assistance to oversee new learning activities
Transport and accompaniment support to medical, specialist and therapy appointments and to access his essential services
...requires practical support to get his 4ww out of the car when attending reviews. He is safer using his 4ww than walking stick. Further, he requires indirect assistance from his support workers during consultations to help him understand complex medical information and/or assist with any follow-up requests such as arranging blood tests, scans and/or changes to his medications
Support worker assistance with heavy laundry
Support worker assistance with meal preparation tasks
Support worker assistance with shopping duties
Commercial support for large housing cleaning tasks (bathroom, floors ec)
Commercial support with lawn moving duties
Nil
This will allow ... to maintain a level of independence with aspects of cooking. The time/frequency recommended includes dish washing and kitchen cleaning after cooking.
This provides him with the opportunity to remain socially engaged with his community. He also requires support with un/packing/ Online shopping is not suitable
Nil
Nil
1.5hours per week
7.00 hours per week. That is an allowance of 1 hour per day of meal preparation tasks
3 hours per week
2 hours per week
1 hour per week. This is an allowance for 2 hours per fortnight.
Support worker assistance to oversee self-management tasks (such as appointments, medications etc)
(1) The decision of the respondent to approve a Statement of Participant Supports dated 14 August 2023, as varied by the decisions of the respondent made on 8 October 2024 and 26 June 2025 to vary and further vary that Statement of Participant Supports, is affirmed.
Mr W Robin, Multicultural Disability Advocacy Association
[1] This proceeding commenced before the Administrative Appeals Tribunal (AAT) in accordance with the power conferred by s 25 of the administrative Appeals Tribunal Act 1975 (Cth). The AAT was abolished and replaced by the ART with effect from 14 October 2024. By operation of Item 24 in Schedule 16 of the Administrative Review Tribunal (Consequential and Transitional Provisions No 1) Act 2024 (Cth) any proceeding which was not determined by 14 October 2024 continues in the ART and is to be determined by the application of the provisions of the ART Act.
[2] The effect of this variation decision was to 'replenish' funding for previously approved supports for an extension period while this case remained before the Tribunal.
[3] Drake v Minister for Immigration and Ethnic Affairs [1979] FCAFC 39; 24 ALR 577 (Drake) at 589.
[4] Shi v Migration Agent's Registration Authority [2008] HCA 31; (2008) 235 CLR 286 at [45] - [46].
[5] National Disability Insurance Agency v Davis [2022] FCA 1002 (Davis) at [60].
[6] Beezley v Repatriation Commission [2015] FCAFC 165 (2015); 150 ALD 11 at [68]; HPSC and National Disability Insurance Agency [2021] AATA 727 at [85].
[7] Forrest and National Disability Insurance Agency (NDIS) [2025] ARTA 1131.
[9] Other than the medical and allied health reports filed with the access request, I base these conclusions principally on the analysis of the Applicant's Health conditions set out in the Sale report at page 231 of the Hearing Bundle and the Williams report at page 186 of the Hearing bundle.
[10] These impairment descriptions are derived from Chapters 1, 2, 6 and 7 of the World Health Organisation (2011) International Classification of Functioning, Disability and Health, Geneva (ICF); see also, World Health Organisation (2002), Towards a Common Language for Disability, Functioning and Health, ICF, Geneva
For a discussion of the relevance of the ICF to NDIS proceedings in providing a standardised language and conceptual framework see my decision in DQKZ and National Disability Insurance Agency [2024p AATA 2276 at [144] - [149].
[11] See my explanation of this in Burrows and CEO, National Disability Insurance Agency (NDIS) [2025] ARTA 607 at [38] - [40].
[12] I do not understand this to be in issue, but to any extent that it is I rely upon the Sale report as to the Applicant's functional capacity in this domain; page 243 of the Hearing Bundle. Mr Williams notes in his report at page 155 of the Hearing Bundle that the Applicant "is finding it increasingly difficult to register verbal information which is affecting his receptive communication" and that "this causes [him] to occasionally require people to repeat themselves to help him process the information and understand what they are saying to him", but I do not understand this to be a contention that he experiences substantially reduced functional capacity for receptive communication.
[13] The scope of the social interaction activity area is determined by reference to the Agency's operational guidelines, supplemented by parts of Chapter 7 of the ICF: Foster and National Disability Insurance Agency (NDIS) [2025] ARTA 718 at [67] and [87 iii].
[14] Sale report at pages 244 - 245 and 256 - 257 of the Hearing Bundle. As part of his assessment, Mr Williams completed a follow-up COGNISTAT Standardised Cognitive Assessment. He reported a severe deficit in the Applicant's ability to immediately recall words and a mild deficit with the immediate recall of a sentence, but otherwise no cognitive deficits were detected.
[15] Letter to the Applicant's General Practitioner, Dr N Usmani, from Dr B Hassan, Consultant Neurologist, dated 21 December 2021. Ms Sale also refers in her report at page 256 of the Hearing Bundle to a letter dated 26 September 2023 written by an unidentified General Practitioner which reports a diagnosis of vascular dementia, but which otherwise states: "patient is otherwise assessed today as being alert and orientated to time, place and person. He is able to recall appointment times and reportedly manage many small tasks on his own including his finances, bills, medical appointments etc".
[16] Page 24 - 26 of the Hearing Bundle.
[17] I take this summary from the information the Applicant provided to Mr Williams and Ms Sale which is included in their reports and from the Applicant's oral evidence on the first day of the hearing.
[18] These details of the request are helpfully set out in the Sale report at page 235 of the Hearing Bundle.
[19] Williams report at pages 190 -196 of the Hearing Bundle.
[20] Sale report at page 234 - 235 of the Hearing Bundle.
[21] Tate, R, L (2017) Manual for the Care and Needs Scale (CANS). Unpublished manuscript, John Walsh Centre for Rehabilitation Research, University of Sydney, Updated version 2.
[23] Williams report at page 189 of the Hearing Bundle.
[24] Sale report at page 251 of the Hearing Bundle.
[25] Williams report at page 181 of the Hearing Bundle. Sale report at page 251 of the Hearing Bundle.
[26] Sale report at page 251 of the Hearing Bundle.
[27] Williams report at page 181 of the Hearing Bundle. Sale report at page 251 of the Hearing Bundle.
[31] Sale report at page 252 of the Hearing Bundle.
[33] Williams report at page 181 of the Hearing Bundle; Sale report at pages 250 - 251 of the Hearing Bundle. Oral evidence of the Applicant, day 1 of the hearing.
[34] Sale report at page 250 of the Hearing Bundle.
[35] Applicant's oral evidence, day 1 of the hearing.
[36] Williams report at page 181 of the Hearing Bundle.
[37] Applicant's oral evidence, day 1 of the Hearing.
[38] Sale report at page 250 of the Hearing Bundle. Applicant's oral evidence day 1 of the hearing.
[39] Williams report at page 181 of the Hearing Bundle. Sale report at page 252 of the Hearing Bundle.
[40] Sale report at page 252 of the Hearing Bundle.
[44] Applicant's oral evidence day 1 of the Hearing.
[45] Applicant's oral evidence, day 1 of the Hearing.
[46] Sale report at page 245 of the Hearing Bundle.
[47] Ibid; Applicant's oral evidence, day 1 of the Hearing.
[48] Ms Sale's report at page 245 of the Hearing Bundle.
[50] Ms Sales report at 249 of the Hearing Bundle.
[54] Ms Sale's report at page 245 of the Hearing Bundle.
[59] Mr Williams at page 182 of the Hearing Bundle.
[60] Applicant's oral evidence, day 1 of the Hearing.
[61] Ibid; see also Mr Williams' report at page 182 of the Hearing Bundle.
[63] Mr Williams at page 182 of the Hearing Bundle.
[64] A grab rail is depicted in a photograph of the Applicant transferring from the toilet in Ms Sale's report at page 248 of the Hearing Bundle.
[66] Mr Williams opines that 'close standby assistance' is required due to limited lower limb strength and weakness (at page 182 of the Hearing Bundle).
[67] Ms Sale at 249 of the Hearing Bundle.
[68] Ibid at page 250 of the Hearing Bundle.
[69] Applicant's oral evidence, day 1 of the Hearing.
[70] These tasks and actions appear in Chapter 6 of the ICF, not in Chapters 4 and 5.
[71] Sale report at 254 of the Hearing Bundle.
[73] Ibid at 252 -253 of the Hearing Bundle.
[74] Sale report at page 253 - 254 of the Hearing Bundle.
[75] Applicant's oral evidence day 1 of the Hearing.
[76] This critique is found in the Applicant's oral evidence, the oral submissions made on his behalf at the hearing and in the Williams report at page 186 - 189 of the Hearing Bundle.
[77] This is encapsulated in the paragraph 34(1)(e) consideration.
Beezley v Repatriation Commission (2015) 150 ALD 111; [2015] FCAFC 165
Burrows and CEO, National Disability Insurance Agency (NDIS) [2025] ARTA 607
Drake v Minister for Immigration and Ethnic Affairs [1979] FCAFC 39; 24 ALR 577
DQKZ and National Disability Insurance Agency [2024] AATA 2276
Forrest and National Disability Insurance Agency (NDIS) [2025] ARTA 1131
Foster and CEO, National Disability Insurance Agency (NDIS) [2025] ARTA 718
Shi v Migration Agent's Registration Authority [2008] HCA 31; (2008) 235 CLR 286
McGarrigle v National Disability Insurance Agency [2017] FCA 308
(2008) 235 CLR 286