Why compensation matters to the NDIS
Compensation here means a lump sum or periodic payment for a personal injury, where at least part of it is for the cost of care or supports. It can come from a court judgement, a settlement, or a state or territory statutory scheme such as a motor accident or workers compensation scheme.
The NDIS is meant to complement those arrangements, not replace them. So if your compensation covers a type of support, the NDIA will not fund the same thing again. It does not change your right to claim compensation in the first place.
Tell the NDIA early
If you are making a claim, are likely to, or have already received compensation for an injury linked to your disability, tell the NDIA. Your plan can then be built with the right information, and you avoid a large adjustment later. The NDIA's compensation team is reachable on 1800 800 110 or compensation@ndis.gov.au.
If you are part of a statutory scheme that already funds some of your care, your NDIS plan usually focuses on the supports that scheme does not cover.
The compensation reduction amount
If your settlement or judgement includes money for future care and supports of a kind the NDIS funds, the NDIA works out a compensation reduction amount (CRA). This is the part of your compensation you are expected to put towards your own care and support.
The CRA is spread across your future plans rather than taken from one plan. The NDIA has an online calculator that gives an estimate, but your actual CRA is based on the information it receives after your claim is finalised, so it can differ.
Recovering past NDIS payments
If your claim is finalised after you became a participant, the NDIA may recover some of what it already paid for supports related to your injury. The recoverable amount cannot be more than the NDIS paid for those supports between the later of the date you entered the NDIS or your date of injury, and the day before your claim was finalised.
The NDIA can also send notices to the insurer or other party paying the compensation, so that the amount owed to the NDIA is paid to it directly before the rest is paid to you. Your lawyer should factor this in before you settle.
If you have not made a claim
If the NDIA thinks you may be entitled to compensation and you have taken no reasonable action to claim it, it can give you written notice asking you to take specific steps. It must consider your disability, your finances, the impact on you and your family, and any reasons you give, and it can only do this if your claim has reasonable prospects of success. You get at least 28 days and can ask for more time.
If you do not act on a notice about a statutory scheme, your plan can be suspended until you do. For other types of claims, the NDIA can take action in your name, after giving you 28 days notice.
Special circumstances and review rights
You can ask the NDIA to consider special circumstances if your situation is unusual, uncommon or exceptional. The NDIA usually looks at a combination of factors, and it may reduce your recoverable amount or CRA.
Many compensation decisions are reviewable, including a notice requiring you to take action, a decision to take over your claim and a notice proposing to recover an amount. You have 3 months to ask for an internal review.
What changes from 1 January 2028
Under the Securing the NDIS for Future Generations changes, people who apply to the NDIS from 1 January 2028 will not be eligible if their impairment was caused by a motor vehicle accident or work related injury and another service system provides compensation or other benefits for that impairment.
Participants who were accessing the NDIS before 1 January 2028 keep their current arrangements, as long as they keep meeting the other eligibility criteria. A new rule, which needs agreement from all states and territories, will set out when another system is taken to provide compensation, so people can still get support while waiting for a compensation decision.