Isherwood and National Disability Insurance Agency

This matter concerned an application for review by the applicant, Ms Isherwood, regarding supports deemed "reasonable and necessary" under the National Disability Insurance Scheme (NDIS) for her daughter, who has Dravet syndrome, epilepsy, intellectual disabilities, and autism spectrum disorder. The applicant sought funding for extensive home modifications and repairs, a new vehicle and modifications, and funding for a current and future seizure alert dog. The National Disability Insurance Agency (NDIA) had not approved these supports, leading to the review before the Tribunal.

The primary legal issue before the Tribunal was whether the requested supports met the criteria of being "reasonable and necessary" as defined by section 34 of the NDIS Act. This required the Tribunal to assess the applicant's functional capacity and determine if the proposed supports were directly related to her disability, cost-effective, and the most appropriate way to meet her needs, considering the objects and purpose of the NDIS. The Tribunal also considered whether the applicant's plan should be fully self-managed, although this aspect was not pursued in the evidence presented.

The Tribunal found that the evidence presented, primarily from the applicant's family members and a general practitioner whose expertise in diagnosing the applicant's conditions was questioned, lacked the independent, objective, and current assessment required to satisfy the "reasonable and necessary" criteria. While acknowledging the family's dedication and the apparent need for home repairs, the Tribunal noted a lack of evidence distinguishing between disability-related modifications and general wear and tear. The Tribunal also highlighted that the applicant's functional capacity and her ability to engage with others had not been independently assessed, despite her attendance at TAFE and stated desire for social interaction.

The Tribunal concluded that it could not be satisfied that the requested supports were reasonable and necessary based on the evidence provided. Consequently, the Tribunal affirmed the NDIA's decision regarding the disputed supports.