The amount of time you will have to give us more information depends on the type of information we ask for. We will write to you to explain what we need and how much time you have.
Eligibility reassessment - 28 days
If we have evidence which indicates you’re no longer eligible, an eligibility reassessment will commence. We will send you a letter to explain why we think you are no longer eligible and give you 28 days to respond, if you think you still meet the NDIS eligibility requirements. If you don’t respond within 28 days, we’ll make the decision based on the evidence that we have.
Example: Eligibility reassessment – potential revocation of status as a participant
Pai is 6 years old. When she was 4 we decided she was eligible for the NDIS under the early intervention requirements for developmental delay. We developed a plan with Pai’s family with early intervention supports that are likely to benefit Pai. The early intervention supports Pai, and her family receive are NDIS supports.
We have regular check ins with Pai and her family. This helps us understand Pai’s progress and the outcomes Pai has achieved. When Pai turns 5, we talk to Pai’s parents about the eligibility requirements. We remind them Pai’s eligibility will be reassessed once she turns 6. This is because Pai will no longer meet the eligibility requirements under developmental delay. To remain a NDIS participant after she turns 6, Pai will need to have an impairment that’s likely to be permanent. Pai will need to meet the requirements for disability, early intervention, or both.
Because Pai is now 6 we start an eligibility reassessment.
We send Pai’s parents a letter. The letter explains that based on the information we have, Pai may no longer meet the eligibility requirements. If Pai’s family think Pai continues to meet the requirements, they need to provide us with evidence. The evidence needs to show that Pai meets the requirements for disability, early intervention, or both. Pai’s parents are asked to respond within 28 days from the date of the letter.
The next day, Pai’s parents call her paediatrician to book an appointment. The paediatrician is currently on holiday. The earliest time they can book an appointment and send us the evidence is 2 months away. Pai’s family send us the booking confirmation for Pai’s paediatrician appointment.
We think about Pai’s current situation. We decide it’s reasonable to give Pai’s family 2 months to provide more evidence.
Pai’s parents provide the evidence in 2 months. We review the evidence. It has the evidence we need to make our decision. We don’t need to request further evidence or a report.
Eligibility reassessment – at least 90 days
If we need specific evidence to make a decision about your eligibility, we’ll ask for this information or a report in a format that helps us to make a decision. We’ll give you at least 90 days to respond. We will support you to get this information.
Example: Eligibility reassessment – continuing to meet NDIS eligibility requirements
Jo is 40 years old and lives with cognitive and physical impairments from stroke. We decided Jo was eligible for the NDIS under the early intervention requirements. Jo has been getting NDIS supports for 14 months. We need to understand if early intervention supports have helped Jo, and if Jo will continue to benefit from early intervention supports that are NDIS supports.
We start an eligibility reassessment.
We send Jo a letter. The letter explains that based on the information we have Jo may no longer meet the eligibility requirements. If Jo thinks they continue to meet the eligibility requirements, they need to provide us with evidence. The evidence needs to show that Jo meets the requirements for disability, early intervention, or both. Jo is asked to respond within 28 days from the date of the letter.
Jo responds by giving us notes from a visit with their general practitioner. The note mentions an assessment by Jo’s neurologist. It’s not enough evidence to decide if Jo meets the requirements for disability, early intervention, or both.
We want to make the right decision. To make the right decision we need evidence from the right treating professional. We send Jo a second letter. The letter helps Jo understand the evidence we need from their treating neurologist. We only request reasonably necessary evidence from Jo. We don’t ask Jo to give us their whole medical record, or reports from every neurology appointment they’ve been to. Jo has at least 90 days from the date of the letter to provide us with the report from their neurologist.
We support Jo to get the evidence we need in an approved form. We contact Jo to make sure they understand our letter and the evidence they need to provide. We also ask Jo to let us know if they need more time to send us the report. We may be able to give Jo more time if their request is reasonable. We won’t make a decision if Jo explains why, it is reasonable to not provide the report in 90 days.
Jo provides a neurology report within the 90 days. The report explains that while Jo has benefited from early intervention, they continue to have substantially reduced functional capacity and will require NDIS supports for their lifetime. We use this report to decide Jo is now eligible for the NDIS under the disability requirements. We update Jo’s eligibility and help Jo build a new plan with NDIS supports for their current situation.
What if you need more time to give us evidence?
If you think you need more time to provide the evidence or send us the report, let us know . We may be able to give you more time if your request is reasonable. You’ll need to tell us why you need more time, and how much time you need. For example, there could be a delay in getting information from your treating professional. If so, we could give you more time so you can get the information and send it to us.
Generally, we’ll only give you one extension of time each time we ask you for more information. This is because the first extension should give you reasonable opportunity to give us the information. If you need another extension, you’ll need to explain why you need more time again and how much extra time you need.
If you give us the information we have asked for, we’ll consider it and decide if you’re still eligible. We will ask you for more information if we need more to make a decision about your eligibility.