McGrath and National Disability Insurance Agency

This matter concerned an application by Ms Erin McGrath against the National Disability Insurance Agency (NDIA) regarding the NDIA's decision to refuse funding for 18 requested supports. The dispute centred on whether these supports were "reasonable and necessary" within the meaning of section 34(1) of the National Disability Insurance Scheme Act 2013 (Cth). The Tribunal considered various documentary evidence and heard oral evidence from the applicant, her counsellor, general practitioner, support person, and occupational therapist.

The primary legal issues before the Tribunal were to determine, for each of the 18 refused supports, whether they met the criteria of being reasonable and necessary. This involved assessing whether the supports were for a disability-related need, whether they represented value for money, whether they were effective and beneficial, and whether they duplicated other supports or were simply day-to-day living costs. Specifically, the Tribunal had to consider the NDIA's contention that an internet connection for a seizure camera was duplicative of existing SIL funding and that cheaper alternatives might exist, as well as the NDIA's argument that internet access is a general living cost.

The Tribunal reasoned that for the internet connection, while the applicant's seizure-like activity was a genuine concern, the evidence did not sufficiently establish the necessity of this specific support. The NDIA argued that the applicant's SIL funding already covered 24/7 active overnight support for seizure activity and that no evidence of cheaper alternatives or an epilepsy management plan had been provided. The Tribunal also noted the lack of a formal epilepsy diagnosis, with medical professionals describing the condition as "seizure-like" or "migraine associated epilepsy type disorder." Furthermore, the Tribunal considered the internet connection to be a day-to-day living cost, which is excluded from NDIS funding under Rule 5.1(d) of the NDIS Support Rules.

Ultimately, the Tribunal found that while the applicant's concerns were genuinely held, some of her requested supports were not sufficiently evidenced as reasonable and necessary. However, the Tribunal did find that specific supports, namely psychology and counselling therapy for two hours per week, four hours per month of yard work, and three hours per week of cleaning, met the criteria of being reasonable and necessary under section 34(1) of the Act, accepting evidence of some deterioration in the applicant's health. The Tribunal also concluded that the applicant's claim for reimbursement of rent was not substantiated, finding that the NDIA had de facto paid her rent through other means, and that the amount claimed was not demonstrably accurate.