What processes are available for complaints and to appeal decisions made by the NDIA regarding a participant?

This section provides an overview of the complaints and appeals processes associated with decisions of the National Disability Insurance Agency (NDIA).
 

What steps can a person with disability take if they have feedback or complaints?

The NDIA accepts feedback and complaints. Formal feedback can be provided by emailing the NDIA directly at feedback@ndis.gov.au or by phoning the NDIA on 1800 800 110. Alternatively, feedback including complaints can be lodged with the NDIA by completing an online complaint form and emailing the completed form to the NDIA on the feedback email noted above, posting the form to the NDIA or dropping the form off at an NDIA office. The NDIA Complaints Procedure requires that the NDIA:

  • take immediate action where there appears to be a high risk of harm, neglect or abuse
  • aim to acknowledge complaints within the next business day from receipt
  • call within two business days of acknowledgement
  • aim to resolve complaints within 21 business days of receipt
  • publish information on NDIA performance[1].

The NDIA will contact the complainant to collect further information if they need to in order to address the complaint. The NDIA will also make contact with the person or organisation the complaint is being made against to advise them about the complaint and request a response. The NDIA will advise the complainant of the response that has been provided and seek to address the concerns.

In the case where a participant is not satisfied with the outcomes, they can request that it is reviewed by a senior person within the NDIA. If the participant is still not satisfied they can take their complaint to the Commonwealth Ombudsman In addition to utilising the NDIA mechanisms for complaints, NDIS participants can also contact a range of other agencies to support them to resolve complaints. A comprehensive list of agencies and their contact details for states and territories can be accessed ​online.

[1] Source - NDIA Feedback and complaints procedure

What steps can a physician take if they have concerns or complaints?

If a physician or other stakeholder would like to raise concerns or has a complaint in relation to a participant, they are able to utilise the same NDIA Complaints Procedure as detailed above. If the concern relates directly to the NDIA it can initially be addressed by the NDIA and should it not be satisfactorily resolved, it can be taken to the Commonwealth Ombudsman If the concerns relate to a provider or stakeholder other than the NDIA, it can be addressed to the NDIA and the NDIA will refer the complaint on to the appropriate agency. Alternatively, complaints can be raised directly with the relevant state or territory agencies whose contact details can be accessed ​online

What steps can a person with disability take if they are not happy with a decision made by the NDIA?

The NDIS Appeals process has been established to ensure that all people with disability, and others affected by reviewable decisions of the NDIA have access to support to have decisions reviewed. The first step for a decision to be reviewed is to apply to the NDIA to have the decision reviewed internally An NDIA staff member will be assigned to undertake the internal review. The appointed person will be independent and will not have been involved in the earlier decision.

How and when can a person lodge a request for an internal review?

When advised about an NDIA decision, advice will be provided on how to request an internal review. An application for internal review of a decision must be made within three months of receiving notice of the decision from the NDIA by completing a formal application.[1] Any person directly affected by a decision of the NDIA can request such a review.

[1] Source - NDIA Internal Review of a Decision

What options are there if a person is not satisfied with the internal review?

If a person is not satisfied with the outcome of the internal review, then an application may be lodged with the Administrative Appeals Tribunal (AAT) for an external review An application for an AAT review must be made within 28 days after a person receives the decision from the NDIA, but extensions can be granted by the AAT.[1] The NDIA appeals process was formally known as the NDIS External Merits Review ​- Support Component.

[1] Source - Department of Social Services NDIS Appeals

What types of decision may be reviewed?

There is a list of reviewable decisions in the NDIS legislation under Chapter 4 Part 6 of the Act. Many decisions made by the NDIA are reviewable, including things like being accepted as a participant, the provision of reasonable and necessary supports, and becoming a registered provider of supports.

How does the AAT process work?

The AAT in preparing to undertake reviews in this new subject area established a new Disability Division made up of members who have expertise and experience interacting with people with disability. The AAT will seek access to all relevant papers from NDIA and the NDIA is required to ensure that copies are provided to the applicant.

The AAT will run case conferences in person or by telephone in a casual setting and focus on open conversation and participation. The AAT has a broad range of alternative dispute resolution possibilities. All applications are considered in one or more early case conferences where the matters under review are discussed along with the best way of dealing with the application. Many applications are settled at case conferences.

An application that does not settle in a case conference may be referred for mediation, conciliation or another form of alternative dispute resolution. In an appropriate case the application is referred to be listed for a hearing.

What does an AAT hearing involve?

In an AAT hearing the expectation is that the applicant will not require legal representation, however the applicant can be assisted by one or more support persons. Other people may give evidence to the AAT in support of the applicant’s case. The AAT usually hands down a decision with full reasons within four weeks of the hearing. The AAT may affirm, vary or set aside the decision under review.

How do I find more detailed information and contacts on the NDIS external appeals processes?

Further information on NDIS Appeals (EMR-SC) is available on the NDIA website at under the following heading: External Merits Review – Support Component (external) In addition, the Department of Social Services website duplicates this information. There is also a disability advocacy finder tool (external) for the National Disability Advocacy Program (NDAP), which includes information on EMR-SC providers.

The infographic below provides an overview of the access, internal review and appeals processes.[1]

NDIA review and appeals processes

[1] Source - graphic created by National Disability Services based on the NDIA Internal Review of a Decision and the Administrative Appeals Tribunal Review of National Disability Insurance Scheme decisions information

How do the access requirements vary for early childhood early intervention?

The Early Childhood Early Intervention gateway provides for a different approach to accessing supports and services specifically for children aged 0 to 6 years of age. The involvement of an Early Childhood Partner as a family’s first point of contact is able to provide immediate support and advice to the child’s family, link them to mainstream services; and supply short term intervention services (where these are determined to be required). Many children and their families will have their support needs met through this process. 

If the Early Childhood Partner determines that the child needs long-term specialised early childhood intervention supports, they will provide assistance to the family to request access to the NDIS for an individualised plan. The Early Intervention Partner will also develop the individualised support plan with the child and family and submit the plan to NDIA for approval.

The NDIA and the Early Childhood Partner will work together to ensure that the plan meets NDIS requirements and meets the child and family’s needs. The Early Intervention Partner is considered to have expertise about early intervention; is knowledgeable regarding the child’s needs; and knows the NDIS requirements. This different access process reduces the likelihood of the individualised plan not meeting the person’s needs therefore decreasing the risk of the need to access review and appeals processes.[1]

The infographic below provides an overview of the access, support and review processes involved in the Early Childhood Early Intervention gateway.[2]
Early childhood early intervention access, support and review
1 Paediatricians, GPs or maternal child health practitioners can refer through existing referral pathways into early childhood intervention. You can also self-refer to your local Early Childhood Partner or contact the NDIA to be directed to your local Early Childhood Partner.
2 The likelihood of the individualised plan meeting the needs of the child and family is increased due to the Early Intervention Partner's expertise in early intervention; knowledge regarding the child's needs; and knowledge of the NDIS requirements.

[1] Source - the NDIA information on Early Childhood Early Intervention
[2] Source - graphic created by National Disability Services based on the information from the NDIA Early Childhood Early Intervention and The role of the Early Childhood Partner

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