NDIS Section 100 Checklist: A Regional Carer Guide to Internal Reviews

💡 At a Glance

⏱ Estimated Read Time: 7 minutes

Central Takeaway: Mastering procedural timeframes and Section 9B evidence framing transforms an internal review from a repetitive request into a vehicle of self-advocacy.

• Section 100 of the NDIS Act is the formal legal mechanism to request an internal review of a reviewable decision.
• Requests must be lodged within a strict statutory window of 3 months from receiving notice of the decision.
• Clinical evidence must be informed and grounded in Section 9B rules to assess functional capacity in a sterilised context excluding environmental variables.
• If the NDIA fails to make a decision within 90 days, it becomes a Deemed Refusal, allowing a direct appeal to the Administrative Review Tribunal (ART).

1. Understanding Section 100 and Reviewable Decisions Under Section 99

Section 100 of the National Disability Insurance Scheme Act 2013 serves as the primary legal mechanism for merits-based reconsideration. It acts as a formal procedural gatekeeper that holds the National Disability Insurance Agency accountable. Rather than submitting a simple “second look,” advocates view Section 100 as a structured legal necessity.

Before requesting an internal review, you must verify that the Agency’s action is classified as a “Reviewable Decision” under Section 99 [Opens in a New Window]. Reviewable decisions include access rejections, plan support approvals, and determinations regarding high support needs status.

Requests for review may be filed by the affected person, their plan nominee, or an authorised representative under Section 74 for children. Ensure that representatives maintain explicit, documented consent to prevent procedural delays by the Agency.

2. Navigating the Section 9B Functional Capacity and I-CAN Pivot

Section 9B acts as a substantive evaluation tool during an internal review. Legislation covering access decisions, plan reassessment and variations, and reasonable and necessary support determinations now contain notes pointing to Section 9B. Under this framework, reviewers assess a participant’s capacity based on the “activity as a whole” within a “sterilised context”. Read Section 9B [Opens in a New Window]

Unlike historical barrier-based models, Section 9B(1)(b) explicitly requires reviewers to exclude environmental and personal circumstances. Clinical evidence must focus strictly on innate physiological and functional impairments.

For child participants, Section 9B(1)(a)(ii) provides a critical exception: functional capacity includes assistance from others if that assistance is “appropriate to the person’s age”.

For example, if a child can attend soccer practice when their parent transports them to the field, then legally the child is treated as having the capacity to attend soccer practice.

This exception forms the primary legal defense against improper “parental responsibility” support declines.

At this point, we need to stop and think about the type of evidence we need to submit.

Section 9B is heavily aligned with the medical model of disability; but Section 34, Reasonable and Necessary Supports is heavily aligned with the social model of disability.

Herein lies a valuable opportunity.

When a participant’s functional capacity is described in such a way, it satisfies the legal requirement and gives the reviewer a baseline of the participant’s functional capacity, but it does not give a picture of the participant’s real world functional capacity. Using I-CAN statements directly from the I-CAN report, of which you should have received a copy, alongside these S.9B functional capacity descriptions, can be applied to real world applications of what is actually reasonable and necessary in the real world.

NDIS REVIEW EVIDENTIARY ARCHITECTURE

Navigating NDIS Internal Reviews: The Two-Tier Evidentiary Framework

📖 Read the full plain-text breakdown of this framework

Framework Overview: The Two-Tier Evidentiary Framework is designed to protect regional NDIS participants against unfair plan reductions during internal review (Section 100) requests:

• Tier 1 — Statutory Baseline (Section 9B): Isolates the participant’s innate physiological or cognitive impairment to establish a permanent statutory baseline under Section 9B of the NDIS Act.
• Tier 2 — Reasonable & Necessary Support Mapping (Section 34): Insulates the submission against NDIA evidence discounting by mapping supports directly against Section 34 criteria and person-centred I-CAN domain statements.
• Informal Care Boundaries & Burnout Mitigation: Explicitly documents informal support capacity limits, family carer fatigue, and sustainable care boundaries under NDIS Operational Guidelines.
• Functional Outcome Alignment: Strictly aligns allied health clinical reports (OT, Speech, Physio) with tangible daily functional goals across home, community, and regional settings.

E.g. Without human assistance or a shower commode, I would have to sit/lie on the shower floor to wash and would only be able to wash the parts of my body I could reach (S. 9B statement of functional capacity). The NDIA’s own I-CAN assessment established that I can participate in my daily showering routine when provided with a mobile shower commode and the direct physical assistance and supervision of one disability support worker. My worker assists me to transfer onto and off the commode, safely manoeuvres my commode within the shower recess and washes my lower back, hair, and lower extremities. My worker must also provide continuous verbal prompting for task sequence and execute post-shower transfers and skin drying to maintain personal safety and skin integrity.

As an aside, it is truly difficult to write these kinds of S.9B statements about participants, as it presents people in an undignified manner.

However, by coupling these two together, you are attempting to prevent the reviewer from misapplying Section 9B rules to reject Section 34 funding and directly address how a support represents value for money, whether it is likely to be effective and beneficial, and the limits of informal care.

3. The 7-Step Section 100 Lodgement Protocol

Executing an internal review requires strict procedural precision to protect your legal standing. Follow these seven steps when lodging a Section 100 request:

4. Deemed Decisions, Urgent Triggers, and Automatic Expansion

Special statutory chains manage Ministerial funding cuts and high support needs cases. Under Section 34A and Section 47B, if a participant requests a variation and the CEO fails to act within 21 days, a decision is taken to have been made not to vary the plan.

This 21-day administrative failure triggers an automatic Section 100(5) internal review. Advocates monitor this window closely for participants requiring continuous 24-hour care.

For participants experiencing acute crisis or hospital discharge, urgent review acceleration requires Agency contact within 48 hours. Furthermore, under Section 101(2), if a plan is varied or replaced while an internal review is pending, the review automatically expands to cover the new decision.

5. Reviewer Authority, Sustainability Rules, and Statutory Outcomes

An internal reviewer performs a de novo review, making a fresh assessment based on all evidence current at the time of review. Under Section 100(6), the reviewer may confirm, vary, or set aside and substitute the original decision.

6. Plain English Jargon Translation Table

7. Frequently Asked Questions

8. Escalation Pathways and Next Steps

If a Section 100 outcome remains unfavorable, or if a Deemed Refusal occurs at the 90-day mark, you have the right to lodge an external review appeal with the Administrative Review Tribunal (ART) under Section 103 within 28 days.

At Steady Guide, Principal Support Coordinator Jenny Mathers maintains a strict active caseload cap of 20 clients to ensure direct, expert-led advocacy for regional families across Toowoomba and the Western Downs.

9. Bibliography & Legal References

Below is the formal reference library supporting this Section 100 Internal Review guide, spanning NDIS legislation, statutory amendments, NDIA operational guidelines, Freedom of Information releases, and practice manuals: