Your NDIS access unlocked

We often hear from stressed and overwhelmed members of the disability community who are unsure how to access the National Disability Insurance Scheme (NDIS) and exhausted at the prospect of gathering the information and evidence they need to support their application for funding.

If you want a trusted adviser by your side while you navigate your path to NDIS entry, we’ve got you.

That’s why we chatted with Elizabeth Hickey of AFA Support Coordination about the top three roadblocks to joining the Scheme and how to overcome them. Read what Elizabeth has to say below.

What documents do you need to establish your eligibility for, and gain access to, the NDIS?

To access the NDIS, you’ll need to apply. This can be done verbally or by completing and submitting an access request form.

All NDIS applications require a number of standard documents or information. If you’re already accessing support through Centrelink, you can consent to the NDIA communicating with them and they can confirm details like your address, date of birth, and citizenship status. If you’re not accessing support, or if you don’t consent to the NDIA communicating with Centrelink, you’ll need to provide proof of those things.

You’ll then need to prove that you have a permanent disability – how much information you need to provide will depend on whether your disability is in the NDIS’ List A: Conditions that are likely to meet the disability requirements or List B – Conditions that are likely to result in a permanent impairment, or if it relates to something not listed.

List A outlines conditions the NDIS considers as permanent disabilities, and which are highly likely to be automatically accepted. List B outlines conditions that are permanent, but you need to provide proof that the condition is likely to result in a permanent impairment and impacts on your daily functional ability. The third category is a condition not listed.

For List A conditions, you’ll need to provide a diagnosis and a letter from your treating team outlining the impact. For List B and unlisted conditions, you’ll need the diagnoses and supporting documents from a range of treating professionals and other supports, providing proof of the impact on your daily life, along with confirmation of permanent impairment. For unlisted conditions, you’ll need extensive evidence of the permanent impairment and will likely need to include a functional capacity assessment (find out more about functional capacity assessments here).

It's important that at least one treating professional (like your specialist or regular doctor) completes section 2 of the NDIS application for the treating professional, or provides a letter that covers permanency, treatment (both past and present) to confirm the condition is fully treated and is now at a maintenance phase, and the impact on functional impairment – focusing on mobility, communication, social interaction, learning, self care and self management.

How do you gather these documents for an NDIS application?

There are a range of places to get the documents needed for an NDIS application. The first place to start is with your regular GP. Typically, a GP will be the best person to assist with completing your access request form or main letter, as they’re going to be the person with a full overview of your condition.

If your condition is primarily treated by another doctor or professional (like a psychologist or psychiatrist) then they may be a good place to start.

For other supporting documents, approaching other treating professionals like physiotherapists, occupational therapists, and speech therapists is important if you already have a relationship. While not required, you can also request evidence of impact from mainstream services, which can be useful – this may be a school, workplace, or other community service where you have a good relationship with someone who can write a letter explaining the impact of your condition and the support you need to participate in that environment.

The final piece of evidence that can be helpful is an impact statement or a ‘Day in the Life of {add your name here}’. This outlines the impact (within the home) of a condition on both the person and those who support that person. It doesn’t need to be in any specific format – it can be a letter, a timetable that shows what a day looks like and the support provided, or closer to a written report. This doesn’t need to be included but it can help to show impact where you don’t have a lot of other evidence.

What are functional capacity assessments and are they required to gain access to the NDIS?

Functional capacity assessments are considered by the NDIS as the gold standard for identifying the impact of a condition on daily life. Most of the time a functional capacity assessment isn’t needed for an application – however, where there’s a question on the impact to daily life, they can be useful to assist (this may be for a ‘List B’ condition or for a condition not listed).

A functional capacity assessment is an assessment that allows your therapists to review how well you do your daily activities and what supports you need to be as independent as possible. Depending on your needs, the assessment may review the following areas: self care, daily living tasks, social interactions, emotional management, mobility, financial management and educational/work participation.

Usually, this will be done through conversations and completion of different tools (WHODAS and PEDICAT are examples of tools used). After the assessment, a report will be developed that outlines recommendations for the support a person may need to participate in daily life.

Tip: I’d typically recommend not getting a functional capacity assessment in the first instance for an application to the NDIS as they can cost a lot of money and may not be needed for access. If you don’t gain access to the NDIS initially, it may be worth getting a functional capacity assessment completed.

What are the top three roadblocks for people applying to access the NDIS and how would you overcome them?

The top three roadblocks are:

1. The documentation and effort needed to apply

The task of collecting the documentation is daunting and can be confronting. The best way to overcome this is to start.

Find someone to assist you and make a list or find a list online of documents needed, start with the easiest and work your way through.

2. Proving permanency and impact

One of the most frequent knockbacks is around permanency and impact of the condition. Make sure professionals state in documents that the condition is permanent and outline impacts based on the areas of self care, daily living tasks, social interactions, emotional management, mobility, financial management and educational/work participation.

3. Doctors being unwilling to complete paperwork

Many doctors note they don’t know what to do for an NDIS application. To remove this roadblock, ask them to use the NDIS application form – if needed, you can print the professional section out for more than one doctor to use as the basis of their report.

Also, make sure to book a long appointment. If your doctor’s surgery has a nurse, you may also be able to get them to help with filling the form out.

What’s something people might not tell you about the NDIS application process that everyone would want to know?

The application process is daunting – and not everyone gets in. Your condition needs to have a substantial impact on your life. It may mean you aren’t eligible now but could be in the future if things deteriorate.

If you’re not successful, there are other supports, and the letter of rejection is an important document to assist moving forward. It can tell you why you weren’t successful – perhaps you hadn’t proven enough of an impact from disability, or perhaps the condition has been fully treated. If you feel this isn’t correct, you can request a review of the decision from the NDIA, and if that’s still unsuccessful, you can apply for a full review through the Administrative Appeals Tribunal.

Support for this can be accessed through one of the advocacy supports – however, please note this process can be hard and can take time.

The rejection letter is important to keep even if you don’t reapply straight away because it provides proof that you’re not eligible for the NDIS and, as such, that you’re eligible for other supports that people in the Scheme can’t access.

One of these supports is extra services within the health system – including occupational therapy and speech programs, ongoing psychology and mental health support, or access to equipment that typically isn’t available unless you’ve been rejected from the NDIS or your condition is purely medical-based. Other supports include extra services in education or housing.

You may also be able to access further supports through Carer Gateway.

We’re here to help

If you have any questions, we’re here to help. You can call us on 1800 958 018 from 8am-5.30pm (SA time), Monday to Friday, or email us at enquiries@myplanmanager.com.au.