Clixby and National Disability Insurance Agency

The Administrative Appeals Tribunal considered an application for review by the Applicant of a decision by the National Disability Insurance Agency (NDIA) delegate. The NDIA's decision affirmed an earlier decision regarding the Applicant's Statement of Participant Supports (SOPS) within her National Disability Insurance Scheme (NDIS) plan. The Applicant's plan included significant funding for core supports, transport, improved life choices, daily living, relationships, support coordination, assistive technology, and Specialist Disability Accommodation (SDA). The NDIA had determined that certain requested supports, specifically funding for SDA single occupancy, self-management of plan management, and increased daily activity supports with 24-hour support worker assistance, were not reasonable and necessary.

The legal issues before the Tribunal included whether the Applicant's requested supports for SDA single occupancy, self-management of plan management, and 24-hour support worker assistance were reasonable and necessary under section 34(1) of the NDIS Act 2013 (Cth) and the relevant Rules. The Tribunal also had to consider the probative value of the evidence presented, particularly in light of the Applicant's behaviour during hearings and the inability to verify certain medical documentation and witness testimony. The NDIA also sought an interlocutory dismissal of the application, arguing that the Applicant's conduct impeded the Tribunal's ability to review the request and progress the matter.

The Tribunal's reasoning focused on the evidence presented and its reliability. While the Applicant's Statement of Lived Experience indicated a need for nursing care, she later referred to general care or support workers. The Tribunal accepted she sought additional support workers at a 1:1 ratio, but this request was withdrawn, rendering the specific nature of the care immaterial. Crucially, the Tribunal found that evidence from certain medical practitioners and a former support person could not be verified due to their unavailability or the inability to confirm the contents of their documentation. The Tribunal noted that the Applicant's behaviour during the hearing significantly undermined her position.

The Tribunal affirmed the NDIA's decision. The Applicant's requests for SDA single occupancy, self-management of plan management, and increased daily activity supports with 24-hour assistance were found not to be reasonable and necessary, primarily due to insufficient probative evidence to support these specific needs.