NDIS Case Review: Paul v NDIA (April 2025)
- Tomika Hillebrand
- May 7, 2025
- 3 min read
Decision:
The Tribunal set aside the NDIA's decision under review pursuant to s105 of the ART Act 2024 (Cth).
The Tribunal decided that Paul meets the disability requirements. He has now gained access to the NDIS.
Background:
Paul is a 64-year-old man from Tasmania with both physical and psychosocial conditions including Neuropathic pain, Phantom limb pain, Amputation of left fingertip, Chronic Fatigue Syndrome, Migraines/Tension headaches, PTSD, and Anxiety & Depression.
Paul made an application to become a participant of the NDIS in early 2022. He was advised in August 2022 that he did not meet access. He sought an internal review and the original decision was confirmed and upheld. In October 2022, Paul submitted an application for review in the Administrative Review Tribunal (ART).
Questions for the Tribunal:
In this matter, the Tribunal had to answer two questions in trying to determine whether Paul meets the access criteria:
(1) Does Paul have substantially reduced functional capacity in the domain of social interaction?
(2) Does Paul likely require support under the NDIS for his lifetime?
Deliberation:
Reduced functional capacity:
The evidence provided by Paul was significant and was provided by practitioners who had been supporting him for a long period of time.
The NDIA engaged an Independent Medical Examiner to perform an Independent Medical Examination. Even this practitioner had conceded that there are some environments that inherently trigger Paul's PTSD and that there are other environments that would be more suitable for him based on his needs.
Having considered this, the Member was of the opinion that this was a strong indicator that Paul had actually experienced a substantially reduced functional capacity in the domain of social interaction.
NDIS support for a lifetime?
The NDIA already conceded that Paul’s impairments arising out of his Neuropathic pain, phantom limb pain, left fingertip amputation, and psychosocial impairments attributable to PTSD are permanent. Therefore, the Member noted that there was an inevitable link between that permanency and Paul's need for NDIS support for the remainder of his life.
The Member also said that the mainstream services that the NDIA tried to pass the ball to, did not and do not meet Paul's needs.
Tomika's Standouts:
Post-Hearing Submissions
The NDIA’s final submissions were received by the Tribunal in March 2025. The NDIA claimed that Paul’s evidence should not be afforded significant weight because he was: “inherently unreliable”, “inconsistent”, “evasive” etc.
The NDIA noted that it was disappointing the participant did not call on his GP and psychologist to provide oral evidence during the hearing. The NDIA attempted to infer that the reason why Paul did not call upon them was because they would not provide supporting evidence for his case.
The NDIA also noted that Paul abruptly ceased giving oral evidence during the hearing and that was supposedly an indicator that he was unreliable. They failed to mention that the participant had been discharged from hospital just three days prior after a 12-day stint in hospital. Paul was readmitted for a further 4 days after experience a seizure while giving evidence.
The Member stood up for Paul and stated at [154] “I consider these to be serious omissions given the serious assertions in the closing submissions as to Mr Paul’s lack of credibility and evasiveness when giving his evidence.”
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