Hiney and National Disability Insurance Agency

This matter concerned an application by Mr Hiney for review of a decision by the National Disability Insurance Agency (NDIA) regarding his statement of participant supports. Mr Hiney sought access to a preferred prosthetist, Barry Leech, for the fitting of a prosthesis for his right lower limb. The dispute centred on whether the NDIA's decision adequately provided for Mr Hiney's needs, particularly in relation to the quality and fit of his prosthesis, and the associated funding.

The Tribunal was required to determine whether the NDIA's decision was appropriate, specifically concerning the provision of reasonable and necessary supports for Mr Hiney. This involved assessing the importance of a well-fitted prosthesis to Mr Hiney's ability to work, engage in his hobbies, and avoid further pain and potential medical complications, including the risk of further amputation. The Tribunal also considered the NDIA's guidelines regarding quotes for prostheses and the implications of the plan's review date.

The Tribunal accepted Mr Hiney's evidence regarding the significant pain and discomfort he experienced from ill-fitting prostheses, and the detrimental impact this had on his life, including his ability to work and pursue his motorbike riding hobby. It was noted that a poorly fitted prosthesis could lead to further falls, damage to his knee replacement, and potentially necessitate a higher level of amputation. The Tribunal also heard evidence from the director of OPSA, who recommended Mr Leech due to his expert skills in managing Mr Hiney's complex needs, and the prospect of a more durable and comfortable prosthesis. The Tribunal considered that if the NDIA portal had limitations regarding access to funding after a review date had passed, extending the review date would be prudent.

Consequently, the Tribunal varied the NDIA's decision in part, extending the review date of Mr Hiney's NDIS plan to 28 February 2020.