Guide to NDIS compensation

Navigating the intersection of the National Disability Insurance Scheme (NDIS) and compensation can be a complex journey, but understanding how these two realms intersect is crucial for participants seeking support. 

If an NDIS participant or prospective participant receives compensation due to personal injury that has caused or affected their impairment, the NDIS will consider that compensation when allocating funding. If the participant qualifies to receive compensation but has not yet claimed, the NDIA may take action.

At Maple, our aim is to armour you with all of the essential knowledge to navigate the dynamics of NDIS and compensation. We will shed light on how these systems work together to provide you with comprehensive assistance and ensure you receive the best possible support while you manage your compensation claims.

What is compensation?

If you have sustained an injury, loss or harm due to an accident, or wrongful actions by others you may be eligible to seek compensation. Although potentially controversial, compensation aims to be more than just a financial payment; it’s a way to help restore what was lost or damaged or to help you overcome the impact it will have for you moving forward. 

The specific nature of compensation varies depending on the context. However, it is designed to acknowledge and address the impact on your well-being, your finances, and overall quality of life caused by the challenging event or circumstance you’ve faced. 

The financial compensation you receive after sustaining a personal injury or impairment can be allocated towards supports and services to help you gain independence and quality of life. This benefit can be used in conjunction with National Disability Insurance Scheme funding.

NDIS and compensation

The interaction between the National Disability Insurance Scheme (NDIS) and compensation can be complex. If you qualify for or have received compensation, it’s important to understand how they work together or to seek professional advice. 

Compensation will not affect your ability to access NDIS funding. Instead, the essence of your NDIS funding is to complement rather than replace any compensation arrangements for personal injury. It acknowledges that the NDIS shouldn’t alter the process of seeking compensation or impact on someone’s existing rights in cases of injury-induced impairment.

Compensation and NDIS funding

If a participant is eligible for compensation due to a personal injury causing or impacting their impairment, the NDIS takes this compensation into account when allocating funding. The purpose is to avoid “double-dipping”, where the participant receives compensation for the same needs that are covered by their NDIS plan.

Compensation recovery process

The NDIS has a process known as “compensation recovery”. This process ensures that any compensation a participant receives for the same purpose as funded supports under the NDIS is taken into consideration. This process helps prevent any overlapping payments and makes sure all of their resources are allocated efficiently throughout the program.

Notification of Compensation

As an NDIS participant, if you are entitled to or have received compensation, you must be transparent with the NDIA and notify the agency promptly of your claim. This allows the NDIA to assess and adjust your funding accordingly.

If you are eligible for compensation due to an injury but choose not to pursue it, the NDIA might reach out to you and suggest you take the necessary steps. If you don’t follow this advice, it could lead to consequences such as your plan getting suspended, not being approved, the NDIA starting a compensation claim for you, or taking control of an existing claim you might have. 

Will compensation affect my NDIS funding?

With the compensation recovery process in place, the NDIS ensures that any compensation received by participants for the same purpose as funded supports under the NDIS is noted. The NDIS can then recover the costs of supports that are covered by compensation payments so that the system is not overpaying. This allows funding to be allocated to others who need it and ensures that the NDIS remains sustainable way into the future.

The compensation you receive is likely to be factored into the assessment of your NDIS funding going forward. This may depend on the amount you were compensated, any unique circumstances that may arise, as well as the nature of your injury. This means that your NDIS funding may be adjusted based on the compensation you receive to avoid duplication of your benefits. 

How can my Plan Manager help navigate NDIS and Compensation?

Seeking the support of an NDIS Plan Manager can gain you a knowledgeable ally who can guide you through the intricacies of both systems. Plan Managers are familiar with the rules and processes needed to navigate between NDIS and compensation. They can provide guidance on how compensation may impact your specific situation and impart their invaluable experience. 

Your Plan Manager can facilitate communication with the NDIA to make sure they are notified as soon as possible if you are entitled to or have received compensation for any reason related to your impairment. If there are any complexities or challenges that arise during this process, your Plan Manager cna act as an advocate on your behalf. They can liaise with the NDIA, your service providers and other relevant parties to address and resolve any issues.

In addition to advocating for you and providing crucial advice, your Plan Manager can assist you in budgeting your NDIS and compensation funds efficiently. This means they can help you to optimise all of your funding to meet your personal goals while complying with NDIS regulations. At the same time, they can maintain accurate records of all your financial transactions and relevant documentation to ensure your plan remains transparent and in compliance with the NDIS.

NDIS compensation rules

You can find out more about NDIS and compensation on the NDIS website, their Compensation Operational Guideline – Overview outlines how the principles relating to compensation and the relevant legislation.

If you have any questions or wish to discuss your compensation and the NDIS further, you can always reach out to our knowledgeable team at Maple.