King and National Disability Insurance Agency

This matter concerned an appeal by Ms King against a decision of the National Disability Insurance Agency (NDIA) regarding the contents of her participant plan. Ms King, who has spastic quadriplegic cerebral palsy, a mild intellectual disability, and mild vision and hearing impairments, sought to include additional physiotherapy sessions and a gym membership in her plan. The dispute centred on the number of physiotherapy sessions and the specific purpose of some of those sessions, with the NDIA initially proposing fewer sessions and suggesting that some therapy could be delivered by less qualified support workers.

The Tribunal was required to determine whether the physiotherapy treatment recommended by Ms King's physiotherapist, Ms Clatworthy, and her gym membership constituted reasonable and necessary supports under section 34 of the National Disability Insurance Scheme Act 2013 (Cth). This involved assessing whether the supports would assist Ms King to pursue her goals and aspirations, facilitate her social and economic participation, represent value for money, be effective and beneficial, take account of informal supports, and be most appropriately funded by the NDIS.

The Tribunal found that the physiotherapy treatment, specifically Bobath physiotherapy, was effective and beneficial for Ms King, having previously improved her mobility and independence. It was noted that Ms Clatworthy's evidence was not contradicted by the NDIA. The Tribunal considered that the proposed physiotherapy sessions, including those for training carers and home-based sessions, were necessary to maintain Ms King's mobility and prevent deterioration, which would otherwise increase her reliance on her mother and potentially necessitate more costly residential care. The Tribunal also found that the gym membership was a reasonable and necessary support to complement the physiotherapy.

The Tribunal set aside the NDIA's decision and substituted it with an approval for Ms King's plan to include an annual gym membership, fortnightly physiotherapy sessions for the remainder of the plan, and an additional five physiotherapy sessions. These additional sessions were to comprise three for training carers in assisting Ms King with her gym program and two home-based sessions.