CRWR and National Disability Insurance Agency

This matter concerned an application by the Applicant, CRWR, for review of a decision made by the National Disability Insurance Agency (NDIA) regarding funding for supports under the National Disability Insurance Scheme. The Applicant, who has Autism Spectrum Disorder Level 2, sought funding for various therapies and supports, including music therapy, psychology, physiotherapy, occupational therapy, and case coordination. The NDIA had made an offer of support, but the Applicant contended that this offer did not adequately address his reasonable and necessary needs. The Tribunal, presided over by Senior Member P Goward AO, was tasked with determining whether the disputed supports met the criteria of being reasonable and necessary under the Scheme.

The central legal issues before the Tribunal were whether the specific therapies and supports requested by the Applicant, including additional hours of behaviour support, psychology, physiotherapy, occupational therapy, and music therapy, were reasonable and necessary. Furthermore, the Tribunal had to consider the appropriate level and hours of case coordination required, particularly in light of the Applicant's complex needs and the significant impairments of his father, who is also an NDIS participant. The Tribunal also needed to assess the probative value of the evidence presented, including expert evidence and the testimony of the Applicant's father, who has significant personal health challenges.

The Tribunal's reasoning involved a detailed consideration of each requested support against the legislative framework of the NDIS, specifically sections 34(1)(c), (d), and (e) and Rules 3.1, 3.2, 3.4, and 5.1. The Tribunal accepted the NDIA's proposal for an updated Behaviour Support Plan, finding the proposed 30 hours per year reasonable and necessary. It also accepted the NDIA's offer for specified hours of psychology, physiotherapy, and occupational therapy, noting minor gaps in the requested hours for psychology and physiotherapy that would be addressed. The Tribunal acknowledged the Applicant's father's difficulties in managing the NDIS process and his concerns about discrimination, while also noting that a support coordinator had commenced working with them, a fact not initially disclosed. The Tribunal's approach to additional evidence, including that provided by the music therapist after her initial appearance, was also a key aspect of its reasoning.

The Tribunal ultimately set aside the NDIA's decision and remitted the matter for reconsideration. This was based on the Tribunal's findings that certain supports were reasonable and necessary and that the NDIA's original decision did not adequately address the Applicant's needs. The Tribunal indicated it would address the specific hours for psychology and physiotherapy and the issue of additional travel hours for therapists.