Guy and National Disability Insurance Agency

The Administrative Appeals Tribunal reviewed a decision by the National Disability Insurance Agency (NDIA) to affirm its refusal to fund Ms Guy's request for regular access to a sex worker. Ms Guy sought funding for one-hour sessions per fortnight, which included intimate activities, at a cost of $560 per session. The NDIA had initially declined this support, and Ms Guy applied to the Tribunal for a review of that decision.

The Tribunal was required to determine whether the requested support, namely access to a sex worker, constituted "reasonable and necessary supports" under section 34 of the National Disability Insurance Scheme Act 2013 (Cth). This involved assessing whether the support would assist Ms Guy in pursuing her goals, facilitate her social and economic participation, represent value for money, be effective and beneficial, consider informal supports, and be most appropriately funded by the NDIS. Specifically, the Tribunal had to consider if the proposed support achieved comparable outcomes to alternative supports at a substantially lower cost, if it would substantially improve life stage outcomes and be of long-term benefit, and if it was likely to reduce the overall cost of supports in the long term.

The Tribunal reasoned that the proposed support did not represent value for money. It noted that Ms Guy could independently perform personal care tasks such as showering and already engaged in social interaction through a transgender group and personal friendships. Furthermore, evidence indicated Ms Guy did not suffer from physical sexual dysfunction and could achieve sexual release independently. Expert evidence suggested that a sex worker would not improve Ms Guy's functional capacity or provide long-term benefits, especially given her history of engaging such services without substantiated improvement. The Tribunal accepted expert opinion that psychologist supports, rather than sex worker services, were more appropriate for addressing Ms Guy's social and emotional impairments stemming from her Autism Spectrum Disorder.

Ultimately, the Tribunal affirmed the NDIA's decision to decline the requested support. It concluded that the proposed expenditure was not justified on the evidence, as it did not meet the criteria of being reasonable and necessary, particularly concerning value for money and the likelihood of achieving substantial long-term functional improvement.