ZJSG and National Disability Insurance Agency

This matter concerned an appeal by ZJSG against a decision of the National Disability Insurance Agency (NDIA) regarding the supports to be included in her NDIS plan. ZJSG, a participant in the National Disability Insurance Scheme since 2020 due to psychosocial impairments, sought review of her NDIS plan. The dispute centred on whether certain supports, particularly exercise physiology for chronic pain, were "reasonable and necessary" under the NDIS Act 2013 (Cth).

The court was required to determine the scope of "reasonable and necessary supports" under section 34 of the NDIS Act. Specifically, it needed to consider whether supports could be sought for disabilities that did not meet the scheme's access requirements, and whether exercise physiology met the criteria for reasonable and necessary supports. The court also had to assess the existing supports within ZJSG's plan and whether they adequately addressed her goals and needs.

The court reasoned that the term "impairment" in the context of NDIS access requirements served as an administrative tool, and participants could seek supports for disabilities beyond those for which they gained access. The primary test for determining whether supports were "reasonable and necessary" was found in section 34 of the NDIS Act, which outlines several criteria including assisting the participant to pursue goals, facilitating social and economic participation, representing value for money, being effective and beneficial, taking into account informal supports, and being most appropriately funded by the NDIS. The court found that while many of ZJSG's requested supports met these criteria, exercise physiology had not been sufficiently established as reasonable and necessary.

Consequently, the Tribunal set aside the NDIA's decision and remitted the matter for reconsideration. The NDIA was directed to approve a new Statement of Participant Supports for ZJSG that included specific allocations for psychology assistance, psychosocial recovery coaching, support coordination, occupational therapy, physiotherapy, podiatry, continence nurse assessment, support work for social, civic, and community participation, support work for personal care, and cleaning, to be implemented within a specified timeframe.