Mowjood and National Disability Insurance Agency

This matter concerned an application by the applicant for review of a decision by the National Disability Insurance Agency (NDIA) to refuse her access to the National Disability Insurance Scheme (NDIS). The applicant sought access based on chronic pain attributed to rheumatoid arthritis, having withdrawn claims based on other conditions and early intervention provisions. The NDIA had affirmed its original decision to refuse access. The Tribunal was constituted by Senior Member Matthew Groom.

The primary legal issues before the Tribunal were whether the applicant's impairment arising from rheumatoid arthritis was, or was likely to be, permanent, whether this impairment resulted in a substantially reduced functional capacity to undertake mobility and self-care, and whether the applicant was likely to require NDIS support for her lifetime. The NDIA conceded the applicant met the age and residency requirements but disputed the permanency of the impairment. The Tribunal considered the relevant provisions of the National Disability Insurance Scheme Act 2013 (Cth) (the Act), the National Disability Insurance Scheme (Becoming a participant) Rules 2016, and the NDIA's Operational Guidelines.

The Tribunal considered the definition of "permanent" under the Rules, which requires that there are no known, available, and appropriate evidence-based treatments likely to remedy the impairment, and that the impairment does not require further medical treatment or review to demonstrate its permanency. The applicant provided evidence of her rheumatoid arthritis since 2003, describing it as a systemic and degenerative condition causing whole-body pain, stiffness, and difficulty with mobility and self-care. The Tribunal was required to determine if sufficient evidence supported the permanency of this condition and its impact on the applicant's functional capacity, as well as the likelihood of lifelong NDIS support.

The Tribunal affirmed the NDIA's decision to refuse the applicant's access to the NDIS. The applicant had sought review of the NDIA's decision to affirm its original refusal, which had been made on the basis that the applicant did not meet the disability or early intervention requirements under sections 24 or 25 of the Act. The Tribunal's decision was made following substantial hearings where both parties were represented by counsel.