NDIS appeals and reviews guide: internal review, AAT process

If you disagree with an NDIS decision, you can request internal review within 3 months (free). NDIA assigns different reviewer who reconsiders decision within 60 days. Success rate 40-50% for internal reviews. If internal review unsuccessful, you can appeal to Administrative Appeals Tribunal (AAT) within 28 days ($100 fee waived for participants). AAT is independent external review with 30-40% success rate. Most appeals focus on: access denials, insufficient funding, rejected assistive technology, or support category allocations.

NDIS Appeals & Reviews at a Glance

Review Type	NDIS Internal Review	AAT External Appeal
Purpose	NDIA reconsiders own decision	Independent tribunal reviews NDIA decision
Who Decides	Different NDIA reviewer	AAT member (independent adjudicator)
Cost	FREE	$100 (waived for NDIS participants)
Timeline	60 days maximum	6-12 months average
Application Deadline	Within 3 months of decision	Within 28 days of internal review decision
Legal Rep Required	No (optional)	No (optional but recommended)
Success Rate	40-50% (full or partial)	30-40%
Decision Binding	No (can appeal to AAT)	Yes (final unless High Court appeal)

Common Appealable Decisions:

NDIS access denial
Plan funding amount (too low)
Rejected assistive technology or home modifications
Support category allocations
Plan management type
Plan duration or review frequency

What NDIS Decisions Can You Appeal?

Reviewable Decisions

NDIS Act 2013 specifies decisions you can request review for:

Access Decisions

Access denial: NDIA decides you do not meet NDIS access requirements
Access approval with conditions: Approved but with limitations or requirements
Early Intervention access denial: Child under 7 denied access under early intervention pathway

Plan Decisions

Plan funding amount: Total plan budget lower than expected or needed
Support category allocations: Insufficient Core, Capacity Building, or Capital Supports funding
Plan duration: Plan shorter than requested (e.g., 12 months instead of 24 months)
Plan management type: Required to use agency management when requesting plan or self-management
Supports not funded: Specific supports excluded from plan (therapy, equipment, respite)

Assistive Technology and Home Modification Decisions

AT rejection: Requested assistive technology not approved
Home modification denial: Home modifications not funded
Quotes rejected: NDIA rejects quotes as excessive or unreasonable
Lower funding amount: Partial approval (e.g., $8,000 approved instead of $15,000 requested)

Plan Review and Variation Decisions

Plan variation denied: Request to add funding or change plan rejected
Unscheduled plan review denied: Request for early plan review rejected
Plan review outcomes: New plan has less funding than previous plan

Provider Registration Decisions (for Providers)

Registration denial: Provider application rejected
Registration conditions: Approved with conditions or limitations
Registration cancellation: NDIA cancels provider registration

Compensation Decisions

Compensation offset: NDIA reduces plan funding due to compensation claim or award

Non-Reviewable Decisions

Some decisions cannot be appealed through internal review or AAT:

Operational decisions: How NDIA administers your plan (e.g., timing of payments, portal access issues)
Provider choice: NDIA cannot force you to use specific provider
Service delivery quality: Complaints about provider service quality (use NDIS Quality and Safeguards Commission complaints process)
Payment disputes between providers and participants: Resolve directly with provider or plan manager

NDIS Internal Review Process

Step 1: Determine If Internal Review is Appropriate

When to request internal review:

You disagree with NDIS decision
You have new evidence (updated reports, changed circumstances)
You believe NDIA misinterpreted information
Decision does not align with reasonable and necessary criteria
Original decision-maker did not consider all relevant factors

When NOT to request internal review:

Decision is more than 3 months old (time limit passed)
You want to complain about NDIS process or service (use complaint process instead)
Provider service quality issue (complaint to NDIS Commission)

Step 2: Gather Evidence for Internal Review

Strongest evidence for internal review:

New Evidence Not Available for Original Decision

Updated functional capacity assessments: New OT, speech pathology, psychology reports showing increased needs
New diagnosis or medical reports: Condition diagnosed or worsened since original decision
Changed circumstances: Living situation, family support, employment status changes affecting support needs

Evidence Clarifying Original Submission

Detailed therapy reports: Speech pathologist, OT, physiotherapist reports explaining why requested supports are reasonable and necessary
Functional impact documentation: Examples showing how disability affects daily living, community participation, employment
Professional opinions: GP, specialist, allied health professional letters supporting funding request

Comparative Evidence

Similar participant plans: Anonymous examples showing participants with similar needs receiving higher funding (obtain through advocacy organizations)
NDIS pricing guide: Evidence that requested supports are within NDIS price limits
Best practice guidelines: Professional association recommendations for intervention frequency (e.g., speech therapy 2x weekly for severe language delay)

Step 3: Submit Internal Review Request

How to submit:

Online via NDIS Portal:

Log in to myplace.ndis.gov.au
Navigate to “Decisions” or “Reviews”
Select decision you wish to review
Complete internal review request form
Upload supporting documents

Email:

Send to: [email protected]
Subject: “Internal Review Request - [Your NDIS Number]”
Attach request letter and supporting documents

Post:

National Disability Insurance Agency
GPO Box 700
Canberra ACT 2601

Phone:

NDIS contact center: 1800 800 110
Request internal review verbally (NDIA will send written confirmation)

What to Include in Request:

Your Details:
- Name, NDIS number, contact information
- Preferred contact method
Decision Being Reviewed:
- Specific decision (access denial, plan funding amount, etc.)
- Date of decision
- Decision reference number (if provided in original decision letter)
Reasons for Review:
- Why you disagree with decision
- What you are requesting (e.g., “increase Capacity Building funding to $15,000”)
- How original decision affects you
New Evidence:
- List all supporting documents attached
- Brief explanation of why each document supports your case
Urgency (if applicable):
- Explain if decision creates safety risk, health risk, or crisis situation
- Request urgent review if appropriate

Step 4: Internal Review Assessment

What happens during internal review:

NDIA Reviewer (Different from Original Decision-Maker):

Receives your request and evidence
Reviews original decision and reasons
Considers new evidence provided
Reassesses against NDIS Act access criteria and reasonable and necessary framework
May contact you, your support coordinator, or health professionals for clarification
Makes independent decision

Timeline:

Acknowledgment: Within 7 days of submission
Decision: Within 60 days of submission
If no decision within 60 days: Decision is deemed affirmed (original decision upheld), and you can proceed to AAT appeal

Step 5: Internal Review Decision

Three Possible Outcomes:

1. Decision Upheld (No Change)

Original decision confirmed
NDIA provides written reasons
Next Step: Appeal to AAT (within 28 days) or accept decision

2. Decision Varied (Partial Approval)

NDIA agrees to some but not all requested changes
Example: Requested $20,000 additional funding, approved for $12,000
Next Step: Accept varied decision or appeal to AAT for remainder

3. Decision Overturned (Full Approval)

Original decision reversed
You receive requested outcome (access approved, full funding provided)
Outcome: Plan updated or new plan issued

Decision Letter Includes:

Outcome (upheld, varied, overturned)
Reasons for decision
What happens next (plan issued, AAT appeal rights)
AAT appeal deadline (28 days from decision date)

AAT External Appeal Process

What is the Administrative Appeals Tribunal (AAT)?

AAT is independent government body that reviews NDIS decisions.

Separate from NDIA
Conducts independent hearings
Makes legally binding decisions
Applies NDIS Act and reasonable and necessary criteria
Can overturn, vary, or uphold NDIA decisions

When to Appeal to AAT

You can appeal to AAT if:

Internal review unsuccessful (decision upheld or partially varied)
You disagree with internal review outcome
Within 28 days of internal review decision (can request extension to 3 months)

Extension Requests:

AAT may grant extension beyond 28 days if you have good reason (illness, awaiting evidence, unaware of deadline)
Request extension as soon as possible

Step 1: Prepare AAT Application

Documents Required:

AAT Application Form: Download from aat.gov.au
Internal Review Decision Letter: Copy of NDIA internal review outcome
Original Decision Letter: Copy of initial NDIA decision
Statement of Grounds: Detailed explanation why you disagree with decision
Supporting Evidence: All reports, assessments, professional opinions

Statement of Grounds Should Include:

Summary of NDIS decision you are appealing
Summary of internal review outcome
Why you believe NDIA decision is incorrect
What evidence supports your case
What outcome you are seeking from AAT

Step 2: Submit AAT Application

How to Submit:

Online:

AAT website: aat.gov.au
Upload application and documents

Post:

Administrative Appeals Tribunal
GPO Box 9955
Sydney NSW 2001 (or your state AAT office)

Application Fee:

$100 (standard fee)
WAIVED for NDIS participants (automatic fee waiver)

Step 3: AAT Case Conference

AAT typically schedules case conference (informal discussion) before formal hearing:

Who Attends:

You (participant or representative)
NDIA representative
AAT case officer (facilitates discussion)
Your legal representative (if you have one)

Purpose:

Clarify issues in dispute
Explore settlement options
Identify evidence needed
Set timeline for hearing

Settlement Opportunity:

Many AAT cases settle at case conference without formal hearing
NDIA may agree to vary decision based on evidence discussed
Settlement avoids lengthy hearing process

Step 4: AAT Hearing

If case does not settle, AAT schedules formal hearing:

Hearing Format:

In-person (AAT office in your state capital)
Video conference (via AAT online platform)
Phone (less common, for simple cases)

Who Attends:

AAT member (decision-maker)
You and your representative/lawyer
NDIA representative (usually lawyer or senior NDIA staff)
Witnesses (if you call health professionals to give evidence)

Hearing Process:

Opening Statements: Each party outlines their case
Evidence Presentation: Documents tendered, witnesses questioned
Cross-Examination: NDIA can question your witnesses, you can question NDIA witnesses
Closing Submissions: Each party summarizes why AAT should find in their favor
AAT Member Questions: AAT member asks clarifying questions

Hearing Duration: 2-8 hours depending on complexity

Step 5: AAT Decision

AAT member provides written decision (usually within 4-8 weeks after hearing):

Possible Outcomes:

Decision Affirmed: AAT agrees with NDIA, original decision stands
Decision Varied: AAT changes part of decision (e.g., increases funding from $15,000 to $22,000)
Decision Set Aside: AAT overturns NDIA decision and substitutes new decision (e.g., access approved, full funding granted)

AAT Decision is Legally Binding:

NDIA must implement AAT decision
No further appeal (except Federal Court on point of law, very rare)

Timeline:

AAT decision typically 6-12 months from application to final decision
Simple cases may resolve in 3-6 months
Complex cases can take 12-18 months

Improving Your Appeal Success Rate

Common Reasons Appeals Fail

Insufficient Evidence:
- No new evidence provided (relying only on original submission)
- Reports outdated (over 12 months old)
- Functional impact not clearly documented
Misunderstanding Reasonable and Necessary:
- Requesting supports not related to disability
- Wanting specific provider or location (NDIS funds supports, not choice of provider)
- Requesting value-improving supports (e.g., expensive gym membership for general fitness)
Poor Articulation of Need:
- Cannot explain how requested support builds capacity or improves independence
- No evidence of functional limitation requiring support
- Requested support duplicates existing mainstream services
Procedural Errors:
- Missed deadline (over 3 months for internal review, over 28 days for AAT)
- Incomplete application
- Failure to respond to NDIA or AAT requests for information

Strategies for Successful Appeals

Obtain Strong Professional Evidence

Most Important:

Functional capacity assessments: OT, speech pathology, psychology assessments showing specific deficits and support needs
Medical reports: Specialist reports documenting diagnosis, prognosis, permanency
Therapy recommendations: Allied health professionals recommending specific intervention frequency and duration

Less Important:

GP letters (general support but less detailed than specialist reports)
Parent or carer statements (supportive but anecdotal)

Clearly Link Supports to NDIS Criteria

Demonstrate:

Supports are directly related to participant’s disability
Supports are reasonable (evidence-based, cost-effective)
Supports are necessary (participant cannot function without them or achieve goals)
Supports build capacity (increase independence over time)
Alternative mainstream supports inadequate or unavailable

Address Value for Money

Explain:

Why requested support is most cost-effective option
Alternatives considered and why they are unsuitable
Long-term benefits and capacity building
Prevention of higher costs (e.g., therapy prevents hospitalization, equipment prevents carer injury)

Use Comparative Evidence

Provide:

Examples of similar participants receiving similar or higher funding
Professional association guidelines for intervention frequency
NDIS pricing guide evidence that requested supports are within price limits

Consider Legal or Advocacy Assistance

Free Legal Help:

Disability advocacy services: Free advocacy for NDIS participants (search “NDIS advocacy [your state]”)
Community legal centers: Free legal advice and representation (search “community legal center [your state]”)
Legal Aid: Free representation if financially eligible

Paid Lawyers:

Disability rights lawyers specializing in NDIS
Costs: $2,000-$10,000+ for full AAT representation
Some offer fixed-fee arrangements or payment plans

Frequently Asked Questions About NDIS Appeals

What is an NDIS internal review?

NDIS internal review is formal reconsideration of NDIA decision by different NDIA reviewer. You can request internal review for: access denials, plan funding amounts, plan variations, support category allocations, assistive technology rejections, plan management decisions. Internal review is FREE and must be requested within 3 months of original decision. NDIA provides decision within 60 days. Success rate approximately 40-50%.

What NDIS decisions can I appeal?

You can appeal most NDIS decisions including: access to NDIS (approval or denial), plan funding amount (too low or categories excluded), plan duration, support category allocations (Core, Capacity Building, Capital), assistive technology rejections, plan management type (self, plan, agency), home modification denials, reasonable and necessary assessments, provider registration decisions (for providers), and compensation determinations.

How do I request NDIS internal review?

To request NDIS internal review: (1) ensure decision is within 3 months (review request deadline), (2) complete NDIS internal review request form or write letter, (3) state which decision you are appealing and why, (4) provide new evidence (reports, assessments, changed circumstances), (5) submit via NDIS portal, email, or post. NDIS must decide within 60 days. Internal review is free and does not require legal representation.

What happens during NDIS internal review?

During NDIS internal review: (1) different NDIA reviewer (not original decision-maker) reconsiders decision, (2) reviews original evidence plus any new evidence you provide, (3) may contact you or health professionals for clarification, (4) reassesses reasonable and necessary criteria, (5) provides written decision within 60 days. Decision can: uphold original, vary original (partial approval), or overturn original (full approval).

Can I appeal to AAT if internal review unsuccessful?

Yes, if NDIS internal review is unsuccessful or you are unhappy with varied decision, you can appeal to Administrative Appeals Tribunal (AAT). AAT is independent external review body. You must apply within 28 days of internal review decision (can request extension). AAT review costs $100 application fee (waived for NDIS participants). AAT conducts independent hearing and makes legally binding decision. Success rate approximately 30-40%.

How long does NDIS internal review take?

NDIS internal review takes maximum 60 days from submission. Timeline: NDIA must acknowledge request within 7 days, review and decision within 60 days total. If NDIA does not decide within 60 days, decision is deemed affirmed (upheld) and you can proceed to AAT appeal. Average internal review completion: 45-60 days. Urgent reviews (access decisions, safety concerns) may be expedited.

Do I need a lawyer for NDIS appeals?

Lawyer not required but recommended for complex cases. Internal review: most participants self-represent with support coordinator or advocacy assistance. AAT appeal: legal representation increases success likelihood. Free legal help available: disability advocacy services, community legal centers, Legal Aid (if financially eligible). Paid lawyers: disability rights lawyers specializing in NDIS. Costs vary ($2,000-$10,000+ for AAT representation).

What evidence strengthens NDIS appeal?

Strong appeal evidence includes: updated functional capacity assessments showing increased needs, new or updated medical reports documenting disability impact, therapy reports demonstrating reasonable and necessary supports, quotes for assistive technology or modifications, evidence of changed circumstances (condition deterioration, new diagnosis), comparative evidence (similar participant plans with higher funding), and expert professional opinions (OT, speech pathologist, psychologist).

Can I get urgent review of NDIS decision?

Yes, urgent review available for decisions affecting: immediate safety or health risks, critical supports not funded, risk of homelessness or crisis, child protection concerns, or hospital discharge requiring immediate supports. Request urgent review when submitting internal review request. NDIA prioritizes urgent cases (decision within 7-21 days). AAT also accepts urgent applications for critical matters.

What are NDIS internal review success rates?

NDIS internal review success rates: full approval (original decision overturned): 15-20%, partial approval (decision varied to include some requested supports): 25-30%, total positive outcome: 40-50%, decision upheld (no change): 50-60%. Success rates higher when new evidence provided. AAT appeal success rates: 30-40% of AAT appeals result in participant-favorable outcome (full or partial).

Key Resources for NDIS Appeals

Official NDIS Information:

Request Internal Review: ndis.gov.au/internal-review
NDIS Decisions and Reviews: ndis.gov.au/decisions-reviews

Administrative Appeals Tribunal:

AAT Website: aat.gov.au
AAT Application Forms: aat.gov.au/apply-for-a-review

Free Legal and Advocacy Support:

National Disability Advocacy Program: nidp.org.au
Community Legal Centers: naclc.org.au/find-a-clc
Legal Aid: legalaid.gov.au

Carevo Resources:

Need help with NDIS appeal or review? Carevo connects participants with disability advocacy services and NDIS specialist lawyers across Sydney and Melbourne. Call 1800 953 253 for assistance navigating NDIS appeals process.

NDIS Appeals & Reviews: How to Challenge Decisions