What the NDIS actually requires, in its own words
Three provisions decide most pain-related decisions. Here is what each one says, and the thing none of them says.
Your refusal letter probably quotes one of three places in the law.
Decision letters are formulaic. They name the requirement that wasn't met and often quote it word for word, which is why the language can feel both very precise and completely unhelpful.
For pain-related decisions, that requirement usually sits in one of three places: section 24 of the Act, the permanence rule in the Becoming a Participant Rules, or section 34 of the Act.
This sets out what each one says. Not what it means for your situation: I can't know that, and nobody should tell you they do from a web page. Just the words, and one observation about all three.
Section 24 sets out who the scheme is for.
Five things have to be true. The impairment must be attributable to an intellectual, cognitive, neurological, sensory or physical impairment, or to one attributable to a psychiatric condition. It must be permanent or likely to be permanent. It must result in substantially reduced functional capacity to undertake one or more of six named activities. It must affect capacity for social or economic participation. And the person must be likely to need support under the scheme for life.
The third of those is where most pain files are decided, and the six activities are named exactly:
National Disability Insurance Scheme Act 2013 (Cth) s 24(1)(c)
Communication · Social interaction · Learning · Mobility · Self-care · Self-management
Pain is not one of them.
That is the single most useful thing on this page. The question is never how much pain you are in. It is what the pain does to communication, to social interaction, to learning, to mobility, to self-care, to self-management, and how much of each is lost.
A record can describe severe, well-documented, entirely genuine pain and still say almost nothing about those six.
Permanence is decided by a rule that sits outside the Act.
This one catches people out, because anyone who goes looking in the NDIS Act won't find it. Permanence is dealt with in the rules: a separate instrument.
National Disability Insurance Scheme (Becoming a Participant) Rules 2016 (Cth): permanence requirements, Part 2
An impairment is, or is likely to be, permanent only if there are no known, available and appropriate evidence-based clinical, medical or other treatments that would be likely to remedy the impairment.
One practical note on finding it: the rule number has moved. Older letters and older commentary cite it as rule 5.4, and it has been renumbered in later compilations of the instrument. If you are checking the wording against the current version on the Federal Register of Legislation, look for the permanence provisions in Part 2 rather than for a particular number.
Read that carefully, because it explains a sentence that appears in a great many refusal letters: "you have not tried all available and appropriate treatments."
Permanence, here, is not about how long you have been unwell. Ten years of pain does not establish it. What the rule turns on is what has been tried, and what each attempt achieved, which is a documentation question as much as a clinical one.
Section 34 decides which supports get funded.
Once someone is a participant, a different provision applies. Section 34 sets out the criteria for a support to be reasonable and necessary, and the section lists them.
National Disability Insurance Scheme Act 2013 (Cth) s 34(1)
That the support assists the person to pursue their goals · assists them to undertake activities that facilitate social and economic participation · represents value for money · is or is likely to be effective and beneficial, having regard to current good practice · takes account of what it is reasonable to expect families, carers, informal networks and the community to provide · and is most appropriately funded through the scheme rather than another service system.
The last of those (whether something belongs to the NDIS or to health, or to another system entirely) is where a lot of pain-related supports come unstuck.
The 2024 amendments added a further requirement, and it matters for pain files. Paragraph 34(1)(aa) requires that the support be necessary to address needs arising from an impairment for which the person meets the disability requirements, so a support has to be tied back to an accepted impairment, not simply to the person's overall condition.
Two things about that provision were settled in Forrest and NDIA [2025] ARTA 1131. The word "meets" is present tense, so the question is asked at the time the statement of supports is approved or reviewed, not fixed to what was recorded when access was granted. And the Note to s 34(1) allows the needs arising from an accepted impairment to be affected by the impact of another impairment the person is not accepted for. In that case pain which did not itself meet the disability requirements was aggravating accepted psychosocial impairments, and physiotherapy and exercise physiology directed at controlling the pain were funded on that basis.
Every one of these describes a state of affairs. Not one describes the evidence.
Read the three provisions again and notice what they have in common.
Section 24 says capacity must be substantially reduced. It does not say what a clinical record has to contain for that to be established.
The permanence rule says there must be no available and appropriate treatment likely to remedy the impairment. It does not say how a treatment history should be documented, or what it takes to show that something was genuinely attempted and didn't work.
Section 34 says a support must be effective and beneficial having regard to current good practice. It does not say what a file must demonstrate for that to be shown.
Legislation names the standard. It does not specify the proof.
That is not a drafting failure; it is how legislation works. Statutes set the test; evidence law and practice fill in what satisfies it. But for someone holding a refusal letter, the consequence is specific and frustrating.
That's why a letter can quote the law at you and still leave you with nothing to do.
The letter tells you which requirement wasn't met. It doesn't tell you which part of your history fell short, what evidence would have made the difference, or whether the problem was that something was never done or that it was done and nobody wrote it down.
You are given a conclusion, and the reasoning that produced it stays where it was.
Knowing what the provisions say doesn't close that gap on its own. But it does change the question you're asking: from why won't they accept how unwell I am to what do my records establish about those six activities, about what was tried, and about what each attempt achieved.
That second question has an answer. It's in your records, and it can be found.
The scope of this article
These provisions are quoted so you can read them yourself, and every citation is here so you can check them against the current version on the Federal Register of Legislation.
This is not legal advice, and it is not an opinion about any individual matter. I'm a physiotherapist, not a lawyer. Decisions about your legal position (review rights, time limits, what to lodge) should be taken with a solicitor or a disability advocate. Free advocacy services exist, and I'm happy to give you the name of one.
What I do is read clinical records and report what they establish and where they stop.
[ How that works → ]
Observations drawn from published Tribunal and Court reasons, current as at the compilations cited. Nothing here is legal advice, and nothing here predicts an outcome. Every file turns on its own facts.