Goder and National Disability Insurance Agency

This matter concerned an application by Mrs Goder, the mother and appointee of the Applicant, seeking a review of a decision made by the National Disability Insurance Agency (NDIA). The Applicant lives with his parents and suffers from multiple diagnosed conditions including Autism Spectrum Disorder (Level 1), Attention Deficit Hyperactivity Disorder, a childhood history of Developmental Delay, Functional Neurological Disorder, and Chromosomal Microdeletion 15q11.2, as well as associated seizures. The dispute centred on the NDIA's decision regarding the provision of supports within the Applicant's National Disability Insurance Scheme (NDIS) plan, specifically concerning requests for consumables, low-cost assistive technology, assistive technology, home modifications, capacity building supports, and the self-management of his plan. The Administrative Appeals Tribunal (AAT) was required to determine whether the NDIA's decision was the correct and preferable one.

The Tribunal was tasked with considering whether the supports requested by the Applicant, and subsequently refused or not funded by the NDIA, constituted "reasonable and necessary" supports under the National Disability Insurance Scheme Act 2013 (Cth). This involved assessing the evidence presented by various treating health professionals, including a clinical neuropsychologist, a physiotherapist, and other specialists, regarding the Applicant's diagnoses, functional limitations, and the potential benefits of the proposed supports. The Tribunal also had to consider the extent to which the Applicant's existing NDIS plan adequately addressed his needs and whether the proposed supports aligned with the objects and principles of the NDIS legislation.

In reaching its decision, the Tribunal considered the evidence of the Applicant's treating professionals, including reports and testimony detailing the impact of his conditions, particularly Functional Neurological Disorder and associated seizures, on his daily functioning and capacity. The Tribunal noted the significant improvements in the Applicant's seizure frequency and impact due to ongoing psychological support and management strategies. While acknowledging the Applicant's desire for improved balance, fitness, muscle strength, functional use of his left hand, and weight loss, the Tribunal found that the evidence did not establish that the specific supports sought, such as certain assistive technology, home modifications, or capacity building supports beyond what was already provided or recommended by his treating team, met the criteria of being reasonable and necessary. The Tribunal affirmed the NDIA's decision.