5. Road map for Compensation Operational Guideline

This Road Map tells you which section of this Operational Guideline is relevant.

What action the NDIA should take depends on the individual circumstances of each case.

Five scenarios are listed below which tell you which section of this Operational Guideline is relevant for different circumstances. In some situations, multiple categories may apply.

A. Where a participant has given up a right to recover compensation?

• When a participant has an impairment caused by a personal injury and has entered into an agreement to give up a right to compensation in respect of that injury, the NDIA may reduce the reasonable and necessary supports under the participant’s plan. See Revise the plan and reduce the supports – agreement to give up compensation.

B. Where a participant has a right to take action to recover compensation?

• When a participant, or prospective participant, is entitled to compensation in respect of a personal injury but has not taken action (or not taken reasonable action) to claim or obtain the compensation, the NDIA may require the person to take action to claim the compensation. See NDIA may require a participant or prospective participant to take action to claim compensation.

C. Where a participant has commenced action to recover compensation?

• When a participant, or prospective participant, has made a claim for compensation against another person or an insurer, the NDIA may issue a preliminary notice or a recovery notice to the person or insurer and recover the compensation directly. See NDIA may recover compensation directly from defendant or insurer.

D. Where a participant has received compensation from another person or an insurer?

• When a participant has received compensation from another person or an insurer in respect of a personal injury that has caused their impairment, the NDIA may reduce the reasonable and necessary supports under the participant’s plan to take account of the compensation. See Revise the plan and reduce the supports – compensation received from a judgement or settlement.
• In addition, if the participant received NDIS supports prior to receiving the compensation, an amount may be payable to the NDIA. See NDIA may recover amount where a participant has received compensation in respect of a personal injury.

E. When a participant has received compensation under an insurance scheme or a government scheme?

• When a participant has received compensation in respect of a personal injury under an insurance scheme or a Commonwealth, State or Territory scheme, the NDIA may reduce the reasonable and necessary supports under the participant’s plan to take account of the compensation. This applies whether or not the person was a participant when they received the compensation. See Revise the plan and reduce the supports – compensation received under an insurance scheme or a Commonwealth, State or Territory scheme.