HKJQ and National Disability Insurance Agency

The applicant, HKJQ, sought review of a decision by the National Disability Insurance Agency (NDIA) that they did not meet the access criteria for the National Disability Insurance Scheme. The NDIA's reviewer had affirmed the original decision. The applicant applied to the Tribunal for a review of the reviewer's decision. The Tribunal was required to determine whether the applicant's impairments resulted in a substantially reduced functional capacity in specified activities, whether they were likely to require lifetime support under the Scheme, and if not, whether they met the early intervention requirements.

The Tribunal considered the applicant's evidence of panic disorder, agoraphobia, and schizoaffective disorder, which had impacted their ability to maintain employment and engage in daily living. Evidence from friends corroborated the applicant's difficulties with social interaction, self-care, and mobility. The Tribunal applied the NDIS Operational Guideline, which outlines the disability requirements for access, including having a permanent disability that results in substantially reduced functional capacity in communication, social interaction, learning, mobility, self-care, or self-management, and affects capacity for social or economic participation. The Tribunal also considered Rule 5.8, which defines what constitutes a substantially reduced functional capacity, requiring inability to participate effectively without assistance, or usual need for assistance, or inability to participate even with assistance.

The Tribunal found that while the applicant's impairments were significant and had caused considerable distress and functional limitations, the evidence did not satisfy the threshold for a substantially reduced functional capacity in the specified activities as defined by the Act and the Operational Guideline. Specifically, regarding communication, a report indicated the applicant could communicate effectively and did not require disability-specific support. The Tribunal affirmed the reviewable decision, meaning the applicant did not meet the disability requirements for access to the Scheme.