NDIS plan not enough? Here’s what to do

So the tense wait is over, you’ve got your NDIS plan, you open it up and…

Your heart sinks.

It’s not what you had hoped for.

Firstly, we know it’s rough - going through the NDIS planning process can be intense. You invest a lot of time and emotional energy every year so it’s normal to feel disappointed if the outcome isn’t what you hoped it would be.

In this blog we’ll look at what you can do if you’re not happy with what’s in your NDIS plan. As always, we promise to do our best to make this a jargon-free zone and explain things in real terms.

Don’t give up hope!

The good news is that there are steps you can take if you feel your NDIS plan isn’t quite what you wanted it to be. Every year thousands of Australians with disability have their plans amended.

Unfortunately, like many things with the NDIS, it can take a fair bit of patience and paperwork to get it sorted. It’s so important that Australians with disability have access to the care and services ;they need - getting your plan fixed can be worth the extra effort and hassle.

Step 1 - Contact the NDIA and request an internal review

The first step is to open up communication with the NDIA. The NDIA are the ones who are responsible for the review. NDIA stands for National Disability Insurance Agency and they are the agency that manages the NDIS. You can get on the phone, email or even write a letter if that’s your style. When you speak to them, let the NDIA know that you would like an internal review of a decision. In this conversation you might be asked to explain why you feel the decision they made is not correct. Remember that the NDIS is all about what’s ‘reasonable and necessary’. The best advice we can give here is to think about why the funding is both reasonable and necessary to you and your particular needs and speak to that.

Here are some questions the NDIA will likely ask you:

• What decision were you expecting?
• Why do you think the NDIA should make a different decision?
• Is there any information you’ve already given the NDIA that you’d like them to reconsider?
• Do you have any new evidence, such as medical or therapy reports, you’d like the NDIA to consider?

After this you may need or want to submit some documentation that looks at how your disability impacts your day-to-day life. The NDIA should be able to recommend what kind of documentation they would need.

Step 2 - Wait

The NDIA will take a bit of time to do their internal review. They aim to complete their review within 60 days of your request. It’s best to know this going in so that you can prepare for a bit of a wait.

In this time, someone from the NDIA will look at all the information you supplied and decide if your request is reasonable and necessary.

It is important to know that you can (and should!) still use any funds you have available to you while this decision is being made. Some people worry that the NDIA will view this as you ‘accepting’ the plan as it currently stands - but that is definitely not the case. You do not have to go without supports while you wait.

At the end of this they will come back to you with their decision. You can ask for them to explain their decision further.

Optional step 3 - Still not happy? Ask for an external review.

If you don’t agree with their decision you can go to the Administrative Appeals Tribunal (AAT). This is sometimes called an ‘external review’. In this review, it won’t be someone from the NDIA looking at your case, but someone who doesn’t work directly for the agency. The goal of the AAT is to resolve things through mutual agreement, so it’s not a court.

Something to be mindful of is that if you want to take your case to the AAT you only have 28 days to do this from the time the NDIA gives you their decision from the internal review. You can only go to the tribunal once the internal review process (step 1) has finished.

You can ask a friend, family member, advocate or lawyer to help you to ask for an external review. If you need help finding an advocate you can connect with one via the NDIS Appeals website.

There has been an acknowledgement that this step could be handled better, so in the months or years ahead there are likely to be changes to what exactly this external step of the review process might look like. Your voice matters so if you have feedback for the NDIA with what they can do better make sure you let them know (you can do this by heading to the NDIS ‘Feedback and complaints’ page).

Everyone deserves access to the supports they need. Getting the right support can make such a difference and is often worth the time, energy and paperwork to make sure the NDIS gets it right.