A Short Case Study & Advice for Clients & Medical Practitioners

While we assist many of our clients through our proprietary HearMe® module to identify their challenges and impairments for their medical practitioners to endorse, it has been reported that our clients still face difficulties accessing the NDIS.

This is a case from one of our clients:

Disability requirements

Based on the available evidence, you do not meet the disability requirements as set out in Section 24 of the NDIS Act, specifically:

Is your impairment likely to be permanent, Section 24(1)(b)

The NDIS Act requires that we consider if you’ll likely have your impairment for your whole life.

Even when your condition or diagnosis is permanent, we’ll check if your impairment is permanent too. For example, you may not be eligible if your
impairment is temporary, still being treated, or if there are remaining treatment options.

The available evidence confirms that you have common variable immune deficiency, chronic fatigue syndrome, fibromyalgia, chronic pain syndrome,
dysautonomia, POTS, osteoporosis, neuropathy, tachycardia, palpitations, Reynaud’s syndrome, cognitive dysfunction, mammalian meat allergy aka
alpha-gal syndrome, insulin resistance, migraines, depression, anxiety, PTSD, ADHD and rejection-sensitive dysphoria.

However, this evidence does not indicate that all available and appropriate treatment options that are likely to relieve or cure your impairments have been explored. These treatment options must be explored before this requirement can be met.

The NDIS Assessment Procedure

Below is NDIS published information which you can access at the NDIS website. However, we highlight some information below that refers to how NDIS assesses permanent impairment:

Is your impairment likely to be permanent?

We need evidence that you’ll likely have your impairment for your whole life.

You might have some periods in your life where there is a smaller impact on your daily life because your impairment may be episodic or fluctuate in intensity. Your impairment can still be permanent due to the overall impact on your life, and the likelihood that you will be impacted across your lifetime. 

Even when your condition or diagnosis is permanent, we’ll check if your impairment is permanent too. For example, you may not be eligible if your impairment is temporary, still being treated, or if there are remaining treatment options.

Generally, we’ll consider whether your impairment is likely to be permanent after all available and appropriate treatment options have been pursued.

If you give us evidence you have been diagnosed with a condition on List B, we’ll likely decide your disability is from an impairment that’s likely to be permanent.

Is there any medical treatment for your impairment?

We don’t fund supports to treat your impairment.

Instead, the supports we fund can help you reduce or overcome the impact your impairment has on your daily life. They can also help you increase your functional capacity, independence, and your ability to work, study or take part in social life.

Your impairment will likely be permanent if your treating professional gives us evidence that indicates there are no further treatments that could relieve or cure it.

Your treating professional will tell us or be asked to certify if there are medical, clinical, or other treatments that are likely to remedy your impairment. We need to understand whether there are treatments that are: 

•    known and available
•    appropriate for you and your impairment
•    evidence-based – that is, there’s proof they are likely to be effective.

The word treatment should be understood in the broadest sense and may include changes to your diet and lifestyle. So, for example, conditions such as obesity are unlikely to be found to be permanent. 

If you’re still undergoing or have recently had treatment, we’ll need to wait until you know the outcome of the treatment before we can decide whether your impairment is likely to be permanent.
 
In some situations, it may be clear your impairment is likely to be permanent while you’re still undergoing treatment or rehabilitation. For example, you may still need treatment and rehabilitation for a spinal cord injury, but it’s clear you’ll have a permanent impairment.

You might still have a permanent impairment, even if its effects may change over time. 

For degenerative impairments or those that get worse over time, we consider them permanent if treatment isn’t likely to help or improve the impairment’s effects. 

HFI Analysis & Advice for Clients & Medical Practitioners 

It is clear in the case we shared earlier that our client suffers from a wide range of illnesses that make their life difficult and their body/ability extremely impaired, so why would the NDIS reject the application? 

The key to the answer is the word “evidence”. The issue we often face is that medical practitioners do not comment on the permanency of the condition in a way suitable to the NDIS, resulting in declines.

We, therefore, suggest the medical practitioner or other approved practitioners address the issues in the following manner:

1. Is my patient undergoing treatment? After listing potential treatments, the medical practitioner should then follow with a statement like, “Any treatment provided may stabilise the condition, however, will not improve their impairments.”
    
2. Is my patient’s impairment lifelong? The answer to this statement can be something like this “My patient has been diagnosed with an illness that has resulted in impaired function that is likely to be lifelong. No treatment available will improve their impairment”.
    
3. Does it satisfy S24? Section 24 refers to the Disability Requirements outlined in the National Disability Insurance Scheme Act 2013 which is available on the Federal Register of Legislation website. This statement may be answered sufficiently by the medical practitioner by stating, “In my view, as an expert in (state medical field of expertise), my patient’s impairments are likely to stabilise/get worse over time without NDIS support. They are lifelong in nature and will not resolve; however, with NDIS support my patient is likely to have a better quality of life”.
    

Of course, these are preliminary suggestions, and you need to speak to your health team to assess whether they believe your impairment is permanent. There is often testing done to measure the level of impairment and such evidence, and this should be included in the NDIS application along with a commentary from your health team.

Why does HFI care about your NDIS outcomes?

The NDIS helps you fund essential therapies and may provide the support that changes your outlook. We know that clients who access the NDIS feel better, make better decisions, and preserve their wealth longer, enabling them to afford a better quality of life. Many of our clients stop working early, and some may secure insurance payouts, but they are usually much worse off financially than clients who do not have health conditions. Those who do not access the NDIS pay for their therapies and care and need to support themselves. This can be extremely costly, and expenses can pile up very quickly.  We, therefore, do whatever we can to stabilise clients’ financial position by encouraging them to access the right systems.

Our Private Clients enjoy unmatched support. Want to find out more?  Call 1300 10 44 99 or Email assistme@healthfinance.com.au