PNMJ v National Disability Insurance Agency [2015] AATA 866 appears to be the first AAT decision to consider a claim for substantial in home care. The Tribunal was required to consider what level of care was reasonable and necessary. It was also required to address, albeit briefly,  what is reasonable to expect families, carers, informal networks and the community to provide.

Ultimately the plan for PNMY (a 3 year old child with a serious neurological disorder) was varied by the Tribunal so as to permit 168 hours of care per week for 6 months (24 x 7 = 168). That was an increase from the 136 hours which had been approved by the NDIA.

The family circumstances were unusual in that the father was a medical professional (at [50]) whereas the mother was also an NDIS participant (at [7]).

There was no question that the child needed 24 hour care (at [81]) with needs well beyond those of a child without disability (at [87] – [88]).

On the issue of reasonable and necessary supports, the Tribunal noted at [106] the need to ensure the financial sustainability of the NDIS. Whilst a review was already underway of the family’s care needs and whilst 136 hours was already a significant level of care, the Tribunal at [103] concluded that the highly complex circumstances warranted 24/7 care for 6 months, with the plan to be reviewed at that point.

On the issue of what is reasonable for informal networks to provide, the Tribunal noted at [96] that whilst there can be no argument about the desirability of supporting and developing the potential contributions of informal and community supports, there had been little opportunity for the parents to develop such networks.

 

 

 

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