VCHG and National Disability Insurance Agency

This matter came before the Administrative Appeals Tribunal concerning an application by VCHG (the applicant) against a decision of the National Disability Insurance Agency (the respondent). The dispute centred on whether certain requested supports for a participant, Mr B, were reasonable and necessary under the National Disability Insurance Scheme. The applicant sought funding for an orthoptist to address functional vision issues and an occupational therapist for travel training.

The Tribunal was required to determine whether the proposed supports, specifically orthoptic services for functional vision and occupational therapy for travel training, 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 these supports would assist Mr B in pursuing his goals and aspirations, facilitate his social and economic participation, represent value for money, be effective and beneficial, and were not more appropriately funded by other systems or informal networks.

The Tribunal considered the evidence presented, including statements from Mr B's carer and an occupational therapist, alongside the legislative framework. It applied the principles outlined in sections 33 and 34 of the Act, which mandate that the Chief Executive Officer must be satisfied that a support assists the participant to pursue their goals, facilitates social and economic participation, represents value for money, is effective and beneficial, and is not more appropriately funded elsewhere. The Tribunal found that the requested orthoptic and occupational therapy services were indeed reasonable and necessary supports for Mr B, aligning with his stated goals and the objectives of the Scheme.

Consequently, the Tribunal set aside the respondent's decision and remitted the matter for reconsideration, with directions to approve the funding for the orthoptist and occupational therapist as reasonable and necessary supports.