Updated: Mar 29, 2019
The pros and cons of requesting an early review
It’s nice to imagine a world exists where everything goes the way you want it to; where a government system operates without potholes, and where no one slips through the cracks.
But the fact is it doesn’t, and the NDIS (National Disability Insurance Scheme) is no different. Your introduction to the NDIS is headlined by keywords like ‘pre-planning’, ‘getting ready’ and ‘making goals’, but what about after that?
What do you do when you’ve received your plan and you realise your funding doesn’t meet your needs? Suddenly your 12-month review can seem an eternity away. If you’re not happy with your plan, this article outlines the internal review process and the pros and cons of requesting an early review of your NDIS plan.
How to request an early plan review
Receiving a plan that looks vastly different to the one you sent away isn’t the only reason why you may want to fast track the date of your next review. So, what are your options?
There are many reasons why you might need to request an ‘unscheduled plan review’:
You’re not happy with the outcome because you’ve realised that your funding is not adequate for the support you need.
Your circumstances have changed, and you need significantly more (or less) support than you were funded for.
Under the NDIS, there are four types of review:
1. Internal review: When you think the NDIA’s (National Disability Insurance Agency’s) decision about your NDIS plan is wrong. Usually, participants request an internal review when they require more funding than they’ve been given, or they have been refused access to the NDIS.
All the information you provided in your planning meeting or access request, and any further evidence that helped make the previous decision, is reconsidered. They will also review any new information that becomes available.
This is a refreshing process because the original planner involved in your funding decision does not conduct the review. This review typically takes a few months. However, you won’t be left without support. While the review is being conducted, you may use the funding provided in the initial plan while it’s under review.
2. External review: An external review becomes available when you disagree with the outcome of the internal review, and wish to challenge the Agency’s (NDIA’s) decision.
To conduct an external review, you must apply to the AAT (Administrative Appeals Tribunal) within 28 days of receiving the result of the internal review. A conference is held, and all evidence of your disability and its impacts are again reconsidered.
The AAT has the power to affirm the decision, or vary it. The decision might be changed in part, or they might make an entirely new decision about your funding.
It’s important to note that if you have had your plan for less than three months, and if special circumstances apply, the NDIA must bypass a request for an ‘unscheduled plan review’ (see below) and apply for an internal review instead.
Both an ‘unscheduled plan review’ and an ‘internal review’ are processes carried out between the Agency and you, the participant. Where as, the ‘external review’ option is a matter of law.
3. Unscheduled plan review: This is a review of your funding based on a change in circumstances. The NDIA have 14 days to decide whether or not to accept the request and review the plan. If they decline, you may wish to open an internal review.
If there are any changes to your circumstances, you must tell the NDIA by law. Some examples of what a change in circumstances are:
Your disability needs change
Your informal care arrangements change significantly
You apply for, receive, or are entitled to compensation for injury
4. Scheduled plan review: The automatic review that occurs at the end of your plan period in preparation for your next plan. Our blog has more information on how to prepare for your scheduled NDIS plan review.
Each review option can be applied for via individual forms located on the NDIS website, or by contacting them.
You might also get help from an advocacy group to help you navigate the review process.
The internal review process: How it works
When you’re not happy with your NDIS Plan you might want to apply for an early, internal plan review. When this review is conducted, your entire plan is put under scrutiny, not just the one decision you asked to be reconsidered. Therefore, it’s recommended you provide strong evidence to justify all aspects of the plan.
There are a number of ways you can provide evidence of the impact of your disability on your life. Ideally, you would have provided this in your initial planning meeting with the NDIA, but if not, now is a great time to provide it.
Support providers, such as therapists, allied health professionals, and advocates, can be pivotal to this process. They can produce reports that justify the supports in the plan.
If you don’t have support providers or advocates currently onboard, First2Care’s Management App can help connect you with these services. The support networks they help to create, plus the planning template they provide, can help you to prepare for future reviews.
TIP: Tools like the First2Care Pre-Planning Template can also help you prepare for your scheduled plan review when it comes time to prepare for your second plan.
Before you request a review, do the research first
To ensure you’re making the best decision possible, it’s important to understand the NDIA’s decision-making processes. We recommend doing some research before heading into a review, as it may be crucial to the outcome.
So, how does the NDIA make its decisions?
The NDIA will only review things that constitutes as a ‘reviewable decision’. Some of them are:
Whether or not you are eligible to be an NDIS participant
Approval of your statement of participant supports
Whether or not to review your requested plan review
For a list of every ‘reviewable decision’, click here.
All the NDIA’s decisions are governed by the National Disability Insurance Scheme Act 2013, which spells out what funding and support is ‘reasonable and necessary’ to you as the participant. It’s a good idea to know what this means for you specifically, but in general this means the NDIS will fund supports for you to:
Reach your goals, objectives and aspirations
Maximise your independence and undertake activities to enable you to participate in the mainstream community and in employment
The Operational Guidelines also help explain how the NDIS operates, including the Scheme’s legal and policy framework, as well as the Act’s objectives and general principles.
If you’re still convinced you need to request an ‘internal review’ you should be prepared for the idea that a review might not go in your favour. We know that feeling unhappy with your funding outcomes can cause a lot of stress.
Deciding to apply for a review can have a big impact on your life, so it’s important you’re clear, calm and informed, rather than upset and emotional when you make this decision. So, it’s a good idea to understand more about the appeals process.
Read about previous appeals and decisions
To get an understanding on who is involved in the decision-making process, and what role each party plays to best prepare you for your review, we recommend reading through previous decisions made by the AAT, which are published on their website.
On this page you’ll find the results of different appeals. They are laid out in report format and link:
The legislation that applied in reaching a decision
The background facts of the participant
The issue they were challenging
And other relevant rules and information that came into play
The AAT explains each step of the process thoroughly. According to the AAT’s Guide for NDIS Appeals statistics, requesting a review under the Tribunal is a worthwhile move.
Importantly, when the Tribunal doesn’t rule in your favour, it’s not necessarily as bad as it may seem, as there are other channels outside of the NDIA that can help you:
Disability Support Pension: Financial assistance if you are between the ages of 16 and 65 and have a physical, intellectual or psychiatric condition that stops you from working.
Carer Payment: Income support if you’re providing constant care for one or more people who has a severe disability, medical condition, or is frail and old, and cannot work because of this.
State-wide Equipment Program: A subsidy towards the cost of equipment and/modifications for people who either have a permanent or long-term disability or are frail or aged.
An example of a previous appeal decision
Here’s an example of a previous case where the decision was not made in favour of the participant.
Gordon Young in the case of Young and the NDIA (2014), is a participant who relied on insulin for his diabetes, and supplementary oxygen for his emphysema.
He appealed to the AAT to challenge an internal reviewer’s decision not to fund such supports as part of his NDIS plan.
Mr Young had access to these supports through other channels, such as the State Wide Equipment Program. Despite this being an inconvenience to Mr Young, the Tribunal ruled that it wasn’t ‘reasonable and necessary’ for the NDIA to take on such funding – because this support was already being supplied by another government department (the State-funded Health Equipment Program).
The NDIS does not replace other current funding systems
However, if a participant with an intellectual disability was required to give themselves an insulin injection, and their capacity for doing this themselves impaired their ability to perform this action – the NDIA may consider funding support to do this for them.
The NDIS is not a perfect system, and never will be. That’s why it’s crucial to know what to do and how best to prepare yourself when things don’t go to plan.
Knowledge is power, so if you’re not happy with your plan arm yourself by making use of the available tools, and if you’re not happy, do your research and plan your review.
Over to you
Are you unhappy with your plan and don’t know what to do? Have your circumstances changed recently or are about to? We hope you have a better understanding of the internal review processes now. Let us know if you have any questions.
Keep the discussion going and comment below.
One last thing… new subscribers to First2Care get 30 days free of the Premium Plan Management features to help you prepare for your next review, so be sure to sign up and start preparing today. Creating your profile is free and easy!