PLPR and National Disability Insurance Agency

This matter concerned an application by PLPR (the applicant) against the National Disability Insurance Agency (the respondent) before Deputy President W Constance of the Administrative Appeals Tribunal. The dispute centred on whether certain supports requested by the applicant, specifically occupational therapy, were reasonable and necessary within the framework of the National Disability Insurance Scheme. The applicant's mother provided evidence detailing the applicant's reliance on her and her limited progress in developing independent living skills, attributing this to a lack of consistent professional support and insufficient carer assistance to implement therapy programs.

The Tribunal was required to determine whether the requested supports, particularly occupational therapy, met the criteria of being "reasonable and necessary" as defined by sections 33 and 34 of the National Disability Insurance Scheme Act 2013 (Cth). This involved assessing whether the supports would assist the applicant in pursuing her stated goals and aspirations, facilitate her social and economic participation, represent value for money, be effective and beneficial according to current good practice, and were not more appropriately funded by other systems. The Tribunal also had to consider the principle that participants should manage their plans to the extent they wish and the operation of previous plans.

The Tribunal's reasoning focused on the statutory requirements for approving participant supports. It noted that under section 33(5), the Chief Executive Officer must consider the participant's goals, relevant assessments, and be satisfied of the matters in section 34. Section 34(1) mandates satisfaction on several points, including that the support assists the participant's goals and social/economic participation, represents value for money, is effective and beneficial, takes account of informal supports, and is most appropriately funded by the Scheme. The Tribunal acknowledged the applicant's mother's evidence regarding the applicant's developmental stage and the challenges in implementing therapy without adequate carer support.

The Tribunal found that occupational therapy was a reasonable and necessary support for the applicant. Consequently, the decision of the respondent was set aside, and the matter was remitted for reconsideration.