Milburn v National Disability Insurance Agency

This matter concerned an application by Ms Milburn against the National Disability Insurance Agency (NDIA) regarding the inclusion of certain supports in her NDIS plan. Ms Milburn, who suffers from multiple significant medical conditions resulting in serious disabilities, sought to have various supports funded under the Scheme, including music therapy, gym membership and personal training, transport and accommodation for family visits, remedial massage, bifocal glasses with prism lenses, specially compounded prescription medicine, and an increase in her transport and community support budget. The NDIA had refused to include these requested supports in her plan.

The primary legal issue before the court was to determine which of the supports claimed by Ms Milburn were "reasonable and necessary" within the meaning of the National Disability Insurance Scheme Act 2013 (Cth) (the Act) and the relevant Rules and Guidelines. This required the court to consider whether each proposed support would assist Ms Milburn to pursue her goals and aspirations, facilitate her social and economic participation, represent value for money, be effective and beneficial, take into account what could reasonably be expected from informal networks, and be most appropriately funded by the NDIS rather than other systems.

The court's reasoning involved a detailed assessment of each claimed support against the criteria for "reasonable and necessary" supports as stipulated in section 34 of the Act. The court noted that all conditions under section 34 must be satisfied for each support. In relation to transport and associated carer services, the court considered evidence suggesting that the existing "on-call" service provided by Nonabel Transport, managed by an individual without relevant qualifications, was not structured to provide value for money or promote independence. The court also considered expert recommendations for an occupational therapist to conduct a community transport assessment to implement independent transport strategies.

Ultimately, the reviewable decision of the NDIA was set aside. The court substituted a new decision to include some, but not all, of the requested supports in Ms Milburn's NDIS plan, based on its assessment of which supports met the statutory criteria for being reasonable and necessary.