NDIS Appeals (External Review) Guide

This is the early stage after the application is lodged. The Tribunal opens the matter, the NDIA begins responding, and the basic documents for the review start to be exchanged.

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This stage is usually about working out what is really in dispute, what further evidence is needed, and whether the NDIA position changes as more material is gathered.

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If the matter does not resolve, preparation for hearing becomes the focus. The Tribunal will set a timetable and the parties will prepare the evidence and arguments they want relied on.

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If the matter has not resolved (which can sometimes happen leading up to hearing), the hearing will go ahead. These usually run for 2–4 days depending on the number of witnesses. The Tribunal then makes a decision based on the evidence and the law.

Key document

Keep a copy of the NDIA internal review decision letter. This is the key document when applying for review to the Tribunal.

Access decisions

These usually focus on whether the person meets the access criteria. Evidence often centres on impairment, permanence, and functional impact.

Support decisions

These usually focus on the support itself, what it is for, how it relates to impairment, and why the evidence supports funding that support.

What you will need

• your contact details
• the date you received the decision
• a copy of the NDIA internal review decision letter
• a very brief reason why you think the decision is wrong
• details of any representative, if you have one

What the review is about

You do not need to write everything at this stage. A simple explanation is enough. You are asking the Tribunal to look at the decision again because you believe it is wrong.

Ways to apply

• online through the ART application process
• using the ART NDIS form and emailing it to reviews@art.gov.au

Internal review first

If you are still at the NDIA stage, focus first on the internal review process. The NDIA says requests for internal review usually need to be made within 3 months of receiving the original decision in writing.

Applicant

The person who has applied to the Tribunal for review. This is usually the NDIS participant, or the person seeking access to the NDIS. A parent or guardian may act on their behalf.

Respondent

The person responding to the application, in this case the NDIA, often through a lawyer or other representative.

Member

The Tribunal decision-maker. A Member usually becomes involved at a hearing. Earlier stages such as directions hearings and case conferences are often managed by a Registrar.

Registrar

A Tribunal officer who may manage conferences, directions hearings, and procedural steps.

Representative

A person acting for a party, such as a lawyer, advocate, or other authorised person.

Directions

Formal steps or orders made by the Tribunal about what must happen next, including dates for documents and evidence.

Directions hearing

A case-management event focused on process rather than final outcome. It often sets a timetable for documents, evidence, and later steps. Directions hearings usually run for about one hour.

Case conference

An informal and private event used to clarify issues, discuss evidence, and explore resolution options. A listing notice may sometimes call this a Case Management Directions Hearing. These events usually run for about one hour.

Conciliation

A more focused, usually longer meeting aimed at resolving the matter if possible. It is often the last major opportunity to resolve the case before hearing. Conciliations usually run for 2 to 3 hours.

T-documents

These are the documents the NDIA used to make the decision. They are taken from the NDIA case file and provided to the Tribunal as part of the review process. Check them carefully. Sometimes not every document provided during the internal review is included.

Statement of Facts, Issues and Contentions

Often called SOFIC. It sets out the facts relied on, the issues in dispute, and the argument about how the law applies. It is usually a document leading up to hearing.

Statement of Issues

A document usually used during the alternative dispute resolution stage. It outlines the history, the issues in dispute, the evidence that may still be needed, and may also record any offer or proposed outcome put forward by the NDIA. It can be updated as further evidence is gathered and is used to help case conference discussion.

Hearing bundle

The organised set of documents used for the hearing.

Summons

A formal Tribunal process requiring a person to produce documents or attend.

Interlocutory hearing

A procedural hearing held before the final hearing. It deals with issues of contention which may need to be resolved before final hearing.

Independent Medical Examination (IME)

An assessment by a medical or allied health professional arranged during the case. This may include an occupational therapist assessing functional capacity or another specialist assessing impairment, treatment, or the appropriateness of supports.

NDIA case manager

A person within the NDIA who manages the matter from the NDIA side. They are the person instructing the lawyers. These are the decision-makers on the NDIA side.

Solicitor, barrister, or counsel

Lawyers representing a party. In NDIS matters, the NDIA will usually engage solicitors, and sometimes barristers, to act on its behalf. Once engaged, the solicitor is often the main point of contact, but the NDIA case manager is still the instructing party.

Hearing

The main Tribunal event where evidence and arguments are presented. It is the final opportunity to put forward your case to a Tribunal Member.

T-documents

These are the documents the NDIA used to make the decision. They are taken from the NDIA case file and provided to the Tribunal as part of the review process. They often include the decision letter, reasons, reports, assessments, plans, and correspondence. Important: check whether all documents previously provided to the NDIA, including at internal review stage, are actually included. If anything is missing, raise it with the Tribunal or the NDIA representative.

NDIA legal representatives

In many matters, the NDIA will engage lawyers after the application is lodged. Once engaged, the NDIA’s solicitor is usually the main point of contact for the process.

Case conference

Usually informal and private. It helps identify the decision under review, clarify what is in dispute, discuss evidence, and explore whether the matter can resolve early. It usually runs for about one hour. These events usually run for about one hour.

Directions hearing

A procedural case-management event. It may set dates for evidence, witness material, responses, and hearing preparation. It usually runs for about one hour. These events usually run for about one hour.

Access evidence (sections 24 and 25)

Access matters usually relate to section 24 of the NDIS Act (disability requirements) or section 25 (early intervention requirements). For section 24, the focus is not just the diagnosis. The key issue is the impairment that results from the condition and whether that impairment causes substantially reduced functional capacity.

It helps if the evidence separates the diagnosis from the impairment. For example, a report may explain that a neurological condition results in impaired balance, fatigue, poor motor coordination, slowed processing, sensory issues, or impaired self-management. That is usually more useful than only naming the condition.

For section 24, the evidence should show what body or mind functions are affected, whether the impairment is permanent, and how it causes substantially reduced functional capacity in one or more of these areas: mobility, communication, social interaction, learning, self-care, and self-management.

For section 25, the focus is more on whether early supports are likely to reduce the future impact of the impairment, improve function, reduce future support needs, or strengthen the sustainability of informal supports.

Support evidence (section 34)

Support matters usually relate to section 34. The evidence should explain what support is needed, what need it addresses, what happens without it, and what practical outcome it is expected to achieve.

The reports do not need to argue the law. It is usually better if providers explain the person’s impairment, daily difficulties, risks, failed workarounds, and the practical reason the support is needed.

The Federal Court in Chief Executive Officer of the National Disability Insurance Agency v Eastham [2026] FCA 147 confirmed that, for section 34(1)(aa), the accepted impairment does not need to be the sole cause of the support need. It is enough if that impairment is a contributory cause. That is important when a person’s real-life need comes from a combination of impairments or other factors, but one accepted impairment is still part of why the support is needed.

Access evidence – key questions

1. Identifying the impairment clearly

• What is the diagnosis or condition?
• What impairment or impairments result from it?
• Can the impairment be described separately from the diagnosis?
• What body functions, mental functions, cognitive processes, sensory functions, or psychosocial functions are affected?
• Which impairment category best describes the person’s impairment: intellectual, cognitive, sensory, neurological, physical, or psychosocial?
• If there is more than one impairment, what are they and how do they interact?

2. Permanency and treatment history

• Is the impairment permanent, or likely to be permanent?
• What treatments, therapies, medication, rehabilitation, or interventions have been tried?
• Over what period were they tried?
• What improvement, if any, occurred?
• Has the impairment been substantially alleviated by conventional treatment?
• If further treatment exists, what is it likely to achieve, and is it likely to remove the impairment or only partly assist?
• If a treatment has not been pursued, is there a clinical reason it is unsuitable, unavailable, unsafe, or unlikely to substantially change function?

3. Substantially reduced functional capacity

• On most days, what ordinary activities of daily life are significantly limited by the impairment?
• Which functional domains are affected: mobility, communication, social interaction, learning, self-care, or self-management?
• What can the person not do, not do safely, not do reliably, or not do without support?
• What happens when the person tries to do the activity without support, prompting, supervision, physical help, or assistive technology?
• Is the problem occasional, or does it arise across a range of routine tasks most of the time?
• Does the person need another person to help, supervise, prompt, interpret, regulate behaviour, or manage risks?
• Would the person be unable to participate effectively in the activity without support?
• What examples from a usual day best show the reduced function?

4. Effect on participation

• How does the impairment affect social participation, community access, education, work, or daily responsibilities?
• What activities are avoided, reduced, abandoned, or only possible with help?
• What isolation, fatigue, behavioural escalation, confusion, distress, or safety risk follows when support is not available?

5. If relying on early intervention

• What early supports are recommended?
• How are they likely to reduce the future impact of the impairment?
• How are they likely to improve function or prevent deterioration?
• How are they likely to reduce future support needs?
• How are they likely to strengthen the sustainability of informal supports, including carers?

Support evidence – key questions

Linking the support to the need

• What support is being requested?
• What need does it address?
• What impairment or impairments are part of the reason that need exists?
• What happens without the support?
• What has already been tried instead, and why is it not enough?

Practical detail

• How often is the support needed and for how long?
• What task, part of the day, environment, or risk does it address?
• Does it improve safety, reliability, endurance, independence, regulation, communication, or access to the community?
• What outcome will it achieve in practical terms?
• What is the likely effect if the support is not provided or is reduced?

Where Eastham may matter

• Does the support need arise from more than one impairment or from a mix of impairment and environmental factors?
• Is at least one accepted impairment a real contributing cause of the need for the support?
• Can the report explain that link clearly in practical terms, without overstating that the accepted impairment must be the only cause?

Information that may come from you, your lived experience, and your carer

Your own evidence is often very important. It can explain what a normal day really looks like, what you are trying to do, what goes wrong, what help is needed, what takes extra time, what is unsafe, and what happens when support is not there.

A lived experience statement can be helpful because it gives practical examples that may not appear clearly in medical notes. It can describe what the person avoids, what they can only do with effort, what happens after activity, how often things break down, and how much prompting, supervision, reassurance, physical help, transport, interpretation, or advocacy is needed.

A carer, partner, parent, sibling, or other family member can also provide a statement. This can explain the support they provide, how often they provide it, what they have to monitor or manage, what happens if they are not available, and the impact on both the person and the carer. You can go into more detail about these statements later in the guide.

Information that may come from professionals

Professional evidence is most useful when it clearly describes the impairment, functional impact, treatment history, and support needs in practical terms, not just the diagnosis.

Professionals who may help, depending on the person’s primary disability and treatment history, include:

• General Practitioner (GP)
• Paediatrician
• Orthopaedic surgeon
• Occupational Therapist
• Speech Pathologist
• Neurologist
• Psychologist
• Psychiatrist
• Physiotherapist
• Other treating allied health professionals or specialists who are well placed to explain the primary disability and its effect on daily function

Prompts that can help you write it

• Describe a usual day from waking until sleep, step by step.
• Explain what you can do by yourself, what you can partly do, and what you cannot do safely or reliably.
• Be specific about showering, dressing, toileting, eating, cooking, medication, moving around, communication, behaviour regulation, appointments, transport, and community access.
• State who helps you, what they do, how often they help, and how long tasks usually take.
• Explain what happens if the help is not there. Include falls, injuries, missed medication, distress, shutdown, meltdowns, confusion, fatigue, pain, isolation, or things not getting done.
• Include supervision needs, prompting, reassurance, redirection, overnight issues, and support with planning or decision-making where relevant.
• Explain how your impairments affect consistency. For example, whether you can sometimes do a task but not do it safely, well, or repeatedly.
• Include aids, equipment, routines, home modifications, or car modifications you rely on and what happens without them.

Simple structure you can follow

1. What impairments affect you.
2. What your day looks like from waking until sleep.
3. Who helps you, when, and with what tasks.
4. What happens if that help is not there.
5. What equipment, modifications, or strategies you rely on.
6. What risks, shutdowns, overwhelm, falls, distress, or deterioration occur.
7. Why the support you seek is linked to actual daily function.

Carer impact statement

A carer or family statement can also be very useful. It explains what support is actually being given, how often it is given, and the impact this caring role has on the carer and the wider household.

• Explain your relationship to the person and how often you support them.
• Describe the practical care you provide each day or week, such as communication support, prompting, behaviour support, mobility help, personal care, transport, meal preparation, medication, cleaning, appointment management, supervision, or overnight support.
• Set out how long tasks take and whether support is needed at set times, across the day, or unpredictably.
• Explain what care goes beyond what would usually be expected, especially where the person is a child.
• Describe the impact on your work, income, health, sleep, relationships, other caring responsibilities, and ability to keep providing support over time.
• Explain what happens to the person, and to you, if this support is not available or cannot continue at the same level.

Creating Your Response

This is general guidance only. It is not legal advice.

Work through the Respondent’s document in order. Be precise. Use page and paragraph numbers. Check what they actually say and go back to the original evidence.

1. State what you agree with.
2. State what you disagree with.
3. Explain why in short numbered paragraphs.
4. Refer to exact evidence (report, page, paragraph).
5. Link it to the legislation or rules where relevant.
6. Check their claims carefully. They may get things wrong or present things selectively.
7. Understand what the NDIA is saying and why, then respond to that directly.

Witnesses

You may need witnesses such as an occupational therapist, doctor, or other professional who understands your daily function and support needs. The ART also has guidance about witnesses and hearing preparation that may be useful.

There is Tribunal guidance on getting ready for hearing, what happens during a hearing, people in case events, and expert and opinion evidence. There is also an expert report cover sheet that can help professionals prepare their material. Experts should know the material they have provided, and it may be useful to show them the criticisms that have been made of their written evidence so they can be ready to address them.

Sometimes a written report is enough. Sometimes you may want the witness there to explain or clarify what they have written. In some matters, the NDIA may also ask that you provide a witness.

Let your witness know early that they may be required. In many cases, they may only need to attend for a short period, often around one to two hours.

It is usually better if witnesses are willing to attend. Relying on formal processes to require attendance can be more difficult, may upset your witness, and may make them less helpful.

The NDIA will generally be required to make its witnesses available for cross-examination. These could include IME professionals they sought during the alternative dispute resolution process. Focus your questions on the evidence they have provided and on anything that seems incorrect, inconsistent, or unclear.

Short examples of how evidence can matter

Helpful links