NDIS Internal Review

An NDIS internal review is a formal process established under Section 100 of the NDIS Act 2013 that allows participants to challenge decisions made by the NDIA regarding their plan. This includes decisions about plan funding levels, support categories, plan duration, or the inclusion or exclusion of specific supports.

The internal review process is conducted by NDIA staff who were not involved in the original planning decision. This independent assessment ensures your case receives fresh consideration based on the evidence and circumstances you present. Importantly, requesting an internal review does not affect your current plan - you continue to access your existing supports while the review is being conducted.

Under the legislation, the NDIA must consider whether supports meet the reasonable and necessary criteria outlined in Section 34 of the NDIS Act 2013. This includes whether the support represents value for money, is likely to be effective, and takes account of what is reasonable to expect families and carers to provide.

Internal reviews are completely free and can be requested by calling 1800 800 110 or through your myGov portal. You have exactly 100 days from when you received your plan to request an internal review, making timing absolutely critical for protecting your rights.

Understanding valid grounds for internal review is essential for building a strong case. The most successful internal reviews focus on demonstrating how the original decision fails to meet the reasonable and necessary criteria or contains factual errors about your circumstances.

Funding inadequacy is the most common ground, particularly in core support categories like Category 15: Improved Daily Living or capacity building supports like Category 7: Support Coordination. For example, if you were allocated 10 hours of support coordination annually but your complex needs require weekly coordination meetings, this represents a clear mismatch between funding and reasonable necessity.

Missing or excluded supports represent another strong ground for review. If your planning meeting discussed specific therapies or equipment needs that don't appear in your final plan, or if supports were excluded without proper consideration of their reasonable and necessary nature, an internal review can address these omissions.

Changes in circumstances since your original plan was developed also constitute valid grounds. If your disability has progressed, your living situation has changed, or new evidence about your support needs has emerged, an internal review can incorporate this updated information into your funding allocation.

Strong evidence is the foundation of successful NDIS internal reviews. The review team needs comprehensive documentation demonstrating why your current plan is inadequate and what specific changes are required.

Medical and allied health reports carry significant weight in review decisions. Current reports from treating practitioners should clearly outline your disability-related needs, recommended interventions, and the frequency or intensity of supports required. For example, an occupational therapist report recommending 20 hours weekly of domestic assistance provides concrete justification for increasing Category 15 funding.

Functional capacity assessments provide objective evidence of your support needs across different life domains. These assessments, conducted by qualified allied health professionals, document your ability to perform activities of daily living and quantify the level of support required. The current price limit for comprehensive assessments is $214.41 per hour for registered psychologists conducting NDIS assessments.

Support provider statements offer practical insights into your actual support needs versus your current plan allocation. Statements from current support workers, coordinators, or service providers can highlight gaps between funded supports and real-world requirements, particularly valuable for demonstrating the inadequacy of current funding levels.

The internal review process follows a structured pathway designed to ensure thorough consideration of your case while meeting statutory timeframes under the NDIS Act 2013.

Step 1: Submit your review request within 100 days by calling 1800 800 110 or logging into your myGov account. You'll need to specify which aspects of your plan you're challenging and provide a brief outline of your concerns. The NDIA will send you a formal acknowledgment within 5 business days.

Step 2: Prepare and submit evidence supporting your review request. While you can submit evidence with your initial request, you typically have 14 days to provide comprehensive supporting documentation. This includes medical reports, assessments, and statements from support providers.

Step 3: NDIA review team assessment occurs over the following 4-6 weeks. The review team, consisting of NDIA staff not involved in your original plan, will examine all evidence and may contact your providers for additional information. They're required to consider your case against the reasonable and necessary criteria in Section 34 of the NDIS Act 2013.

Step 4: Decision notification typically occurs within 42 days of submission, though the NDIA has up to 100 days to complete reviews. You'll receive written notification of the decision, including detailed reasoning for any changes or maintenance of original decisions.

Certain NDIS support categories see higher rates of internal review requests due to complex assessment requirements or frequently inadequate initial allocations. Understanding these patterns helps target your review efforts effectively.

Category 15: Improved Daily Living represents the largest proportion of internal review requests, accounting for approximately 35% of all reviews. This category covers personal care, domestic assistance, and community participation supports, areas where individual needs vary significantly and initial assessments often underestimate requirements.

Category 7: Support Coordination frequently appears in internal reviews, particularly for participants with complex needs requiring higher levels of coordination. Many participants receive basic support coordination funding when they actually need specialist support coordination, which attracts higher hourly rates and allows for more intensive assistance with service delivery.

Assistive Technology categories including consumables, low-cost assistive technology, and home modifications also feature prominently in reviews. These categories require specialist assessment, and initial plans often exclude necessary items or underestimate ongoing consumable needs for participants with complex medical requirements.

Internal review decisions fall into three categories: plan changes in your favour, partial improvements, or confirmation of the original decision. Understanding your options following each outcome ensures you can continue advocating effectively for appropriate supports.

Successful reviews result in an updated plan reflecting increased funding, additional support categories, or inclusion of previously excluded supports. Your new plan becomes effective immediately, and you can begin accessing increased supports. The NDIA will provide written confirmation of all changes and updated service booking information.

Partially successful reviews may increase some funding areas while maintaining others at original levels. In these cases, you need to decide whether to accept the improvements or pursue further review through the Administrative Appeals Tribunal (AAT) for unresolved issues. You cannot request another internal review for the same issues.

Unsuccessful reviews that confirm original decisions provide detailed reasoning for why your evidence didn't support changes. This information becomes crucial for AAT appeals, as it outlines the NDIA's position and helps identify weaknesses in their reasoning or additional evidence needed for external review.

Regardless of outcome, you retain the right to appeal to the AAT within 28 days of receiving your internal review decision. AAT appeals are independent of the NDIA and provide external scrutiny of plan decisions, with approximately 75% of AAT appeals resulting in some form of plan improvement.

Understanding common mistakes helps maximise your chances of internal review success while avoiding delays or rejection of your request.

Missing the 100-day deadline is the most critical error, immediately eliminating your review rights. Many participants assume they can request reviews at any time or wait to see how their plan works in practice before deciding. The deadline runs from when you first receive your plan, not when you start using supports.

Insufficient or outdated evidence significantly undermines review success. Generic medical certificates or reports from practitioners unfamiliar with NDIS requirements often fail to demonstrate reasonable and necessary criteria. Evidence should be specific, current (within 12 months), and directly relate to the supports you're requesting.

Emotional rather than factual arguments don't align with NDIA decision-making processes. While your experience matters, review teams focus on objective evidence demonstrating how supports meet legislative criteria. Personal stories should support factual evidence rather than replace it.

Requesting unrealistic funding increases without proper justification can harm your credibility. Review requests should be proportionate to demonstrated need and supported by professional recommendations. Asking for excessive funding without evidence suggests you don't understand reasonable and necessary principles.