WNLL and National Disability Insurance Agency

This matter concerned an application by WNLL (the applicant) seeking review of a decision by the National Disability Insurance Agency (the respondent) regarding funding for reasonable and necessary supports. The dispute centred on the applicant's need for additional Registered Nurse (RN) funding, specifically for a second RN for 12 hours per day, as opposed to a High Intensity Support Worker (HISW). The applicant's case was that when one RN was present, another RN was required for support, even though the applicant's mother, who lacked formal medical training, often fulfilled this role, and a previously engaged HISW had trained some of the RNs without her status being known.

The core legal issue before the Tribunal was to determine whether the requested funding for a second RN constituted a reasonable and necessary support under the National Disability Insurance Scheme (NDIS) Act. This required the Tribunal to assess the applicant's current support arrangements against her goals of independence and community access, considering the evidence presented regarding her physical condition, daily routine, and the necessity of continuous supervision. The Tribunal also had to consider the evidence regarding the applicant's sedentary lifestyle, her nocturnal waking hours, and the lack of medical explanation for these patterns, as well as the evidence concerning the RNs' duties and the supervision provided.

The Tribunal found that the applicant's current funded level of nursing and care, which provided for an RN 24 hours a day and a HISW for 12 hours a day, was sufficient. It noted that the applicant's goals of independence and community access were not being met, as she was leading an almost entirely sedentary life and did not leave her home except for medical appointments. The Tribunal was not satisfied that the applicant could not go out more frequently, nor was there medical evidence to support the necessity of constant line-of-sight supervision by an RN. The Tribunal concluded that funding for ten hours per day for a High Intensity Support Worker would meet the requirements of a reasonable and necessary support.

Consequently, the decision under review was set aside and remitted to the respondent for reconsideration. The Tribunal directed that the applicant's approved statement of participant supports should specify funding for ten hours per day for a High Intensity Support Worker, that other specified reasonable and necessary supports be replicated until a reassessment date, and that this reassessment date be six months from the date funding for the additional supports was provided.