Task: sc_caseorigin

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Chief Justice Rehnquist
delivered the opinion of the Court.
Pennsylvania provides in its workers’ compensation regime that an employer or insurer may withhold payment for disputed medical treatment pending an independent review to determine whether the treatment is reasonable and necessary. We hold that the insurers are not “state actors” under the Fourteenth Amendment, and that the Pennsylvania regime does not deprive disabled employees of property within the meaning of that Amendment.
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Before the enactment of workers compensation laws, employees who suffered a work-related injury or occupational disease could recover compensation from their employers only by resort to traditional tort remedies available at common law. In the early 20th century, States began to replace the common-law system, which often saddled employees with the difficulty and expense of establishing negligence or proving damages, with a compulsory insurance system requiring employers to compensate employees for work-related injuries without regard to fault. See generally 1 A. Larson & L. Larson, Larson’s Workers’ Compensation Law §§5.20-5.30, pp. 2-15 to 2-25 (1996).
Following this model, Pennsylvania’s Workers’ Compensation Act, Pa. Stat. Ann., Tit. 77, § 1 et seq. (Purdon 1992 and Supp. 1998) (Act or 77 Pa. Stat. Ann.), first enacted in 1915, creates a system of no-fault liability for work-related injuries and makes employers’ liability under this system “exclusive... of any and all other liability.” § 481(a). All employers subject to the Act must (1) obtain workers’ compensation insurance from a private insurer, (2) obtain such insurance through the State Workmen’s Insurance Fund (SWIF), or (3) seek permission from the State to self-insure. § 501(a). Once an employer becomes liable for an employee’s work-related injury — because liability either is not contested or is no longer at issue — the employer or its insurer must pay for all “reasonable” and “necessary” medical treatment, and must do so within 30 days of receiving a bill. §§531(l)(i), (5).
To assure that insurers pay only for medical care that meets these criteria, and in an attempt to control costs, Pennsylvania amended its workers’ compensation system in 1993. 1993 Pa. Laws, No. 44, p. 190. Most important for our purposes, the 1993 amendments created a "utilization review” procedure under which the reasonableness and necessity of an employee’s past, ongoing, or prospective medical treatment could be reviewed before a medical bill must be paid. 77 Pa. Stat. Ann. §531(6) (Purdon Supp. 1998). Under this system, if an insurer “disputes the reasonableness or necessity of the treatment provided,” §531(5), it may request utilization review (within the same 30-day period) by filing a one-page form with the Workers’ Compensation Bureau of the Pennsylvania Department of Labor and Industry (Bureau). § 531(6)(i); 34 Pa. Code §§ 127.404(b), 127.452(a) (1998). The form identifies (among other things) the employee, the medical provider, the date of the employee’s injury, and the medical treatment to be reviewed. Ibid.; App. 5. The Bureau makes no attempt, as the Court of Appeals stated, to "address the legitimacy or lack thereof of the request,” but merely determines whether the form is “properly completed — i.e., that all information required by the form is provided.” Sullivan v. Barnett, 139 P. 3d 158, 163 (CA3 1998); see 34 Pa. Code § 127.452(a). Upon the proper filing of a request, an insurer may withhold payment to health care providers for the particular services being challenged. 77 Pa. Stat. Ann. §531(5) (Purdon Supp. 1998); 34 Pa. Code § 208(f).
The Bureau then notifies the parties that utilization review has been requested and forwards the request to a randomly selected “utilization review organization” (URO). § 127.453. URO’s are private organizations consisting of health care providers who are “licensed in the same profession and hav[e] the same or similar specialty as that of the provider of the treatment under review,” 77 Pa. Stat. Ann.,§531(6)(i) (Purdon Supp. 1998); 34 Pa. Code § 127.466. The purpose of utilization review, and the sole authority conferred upon a URO, is to determine “whether the treatment under review is reasonable or necessary for the medical condition of the employee” in light of “generally accepted treatment protocols.” §§ 127.470(a), 127.467. Reviewers must examine the treating provider’s medical records, §§ 127.459, 127.460, and must give the provider an opportunity to discuss the treatment under review, § 127.469. Any doubt as to the reasonableness and necessity of a given procedure must be resolved in favor of the employee. § 127.471(b).
URO’s are instructed to complete their review and render a determination within 30 days of a completed request. 77 Pa. Stat. Ann. §531(6)(ii) (Purdon Supp. 1998); 34 Pa. Code § 127.465. If the URO finds in favor of the insurer, the employee may appeal the determination to a workers’ compensation judge for a de novo review, but the insurer need not pay for the disputed services unless the URO’s determination is overturned by the judge, or later by the courts. 77 Pa. Stat. Ann. § 531(6)(iv) (Purdon Supp. 1998); 34 Pa. Code § 127.556. If the URO finds in favor of the employee, the insurer must pay the disputed bill immediately, with 10 percent annual interest, as well as the cost of the utilization review. 34 Pa. Code § 127.208(e); 77 Pa. Stat. Ann. § 531(6)(iii) (Purdon Supp. 1998).
Respondents are 10 individual employees and 2 organizations representing employees who received medical benefits under the Act. They claimed to have had payment of particular 'benefits withheld pursuant to the utilization review procedure set forth in the Act. They sued under Rev. Stat. § 1979, 42 U. S. C. § 1983, acting individually and on behalf of a class of similarly situated employees. Named as defendants were various Pennsylvania officials who administer the Act, the director of the SWIF, the School District of Philadelphia (which self-insures), and a number of private insurance companies who provide workers’ compensation coverage in Pennsylvania. Respondents alleged that in withholding workers’ compensation benefits without predeprivation notice and an opportunity to be heard, the state and private defendants, acting “under color of state law,” deprived them of property in violation of due process. Amended Complaint f ¶ 265-271, App. 43-44. They sought declaratory and injunctive relief, as well as damages.
The District Court dismissed the private insurers from lawsuit on the ground that they are not “state actors,” Sullivan v. Barnett, 913 F. Supp. 895, 905 (ED Pa. 1996), and later dismissed the state officials who remained as defendants, as well as the school district, on the ground that the Act does not violate due process, App. to Pet. for Cert. 71a.
The Court of Appeals for the Third Circuit disagreed on both issues. 139 F. 3d 158 (1998). It held that a private insurer’s decision to suspend payment under the Act — what the court called a “supersedeas” — constitutes state action. The court reasoned:
“In creating and executing this system of entitlements, the [State] has enacted a complex and interwoven regulatory web enlisting the Bureau, the employers, and the insurance companies. The [State] extensively regulates and controls the Workers’ Compensation system. Although the insurance companies are private entities, when they act under the construct of the Workers’ Compensation system, they are providing public benefits which honor [s]tate entitlements. In effect, they become an arm of the State, fulfilling a uniquely governmental obligation under an entirely self-contained public benefit system....
“The right to invoke the supersedeas, or to stop payments, is a power that traditionally was held in the hands of the State. When insurance companies invoke the supersedeas (i. e., suspension) of an employee’s medical benefits, they compromise an employee’s [s]tate-created entitlements. The insurers have no power to deprive or terminate such benefits without the permission and participation of the [State]. More importantly, however, the [State] is intimately involved in any decision by an insurer to terminate an employee’s constitutionally protected benefits because an insurer cannot suspend medical payments without first obtaining authorization from the Bureau. However this authorization may be characterized, any deprivation that occurs is predicated upon the State’s involvement.” Id., at 168.
On the due process issue, the Court of Appeals did not address whether respondents have a protected property interest in workers’ compensation medical benefits, stating that “[n] either party disputes” this point. Id., at 171, n. 23. Thus focusing on what process is “due,” the court held that payment of bills may not be withheld until employees have had an opportunity to submit their view in writing as to the reasonableness and necessity of the disputed treatment to the URO. The court then determined that the relevant statutory language permitting the suspension of payment during utilization review was severable and struck it from the statute. Id., at 173-174.
We granted certiorari, 524 U. S. 981 (1998), to resolve a conflict on the status of private insurers providing workers’ compensation coverage under state laws, and to review the Court of Appeals’ holding that due process prohibits insurers from withholding payment for disputed medical treatment pending review.
II
To state a claim for relief in an action brought under § 1983, respondents must establish that they were deprived of a right secured by the Constitution or laws of the United States, and that the alleged deprivation was committed under color of state law. Like the state-action requirement of the Fourteenth Amendment, the under-color-of-state-law element of §1983 excludes from its reach “‘merely private conduct, no matter how discriminatory or wrongful,’ ” Blum v. Yaretsky, 457 U. S. 991, 1002 (1982) (quoting Shelley v. Kraemer, 334 U. S. 1, 13 (1948)).
Perhaps hoping to avoid the traditional application our state-action eases, respondents attempt to characterize their claim as a “facial” or “direct” challenge to the utilization review procedures contained in the Act, in which case, the argument goes, we need not concern ourselves with the “identity of the defendant” or the “act or decision by a private actor or entity who is relying on the challenged law.” Brief for Respondents 16. This argument, however, ignores our repeated insistence that state action requires both an alleged constitutional deprivation “caused by the exercise of some right or privilege created by the State or by a rule of conduct imposed by the State or by a person for whom the State is responsible,” and that “the party charged with the deprivation must be a person who may fairly be said to be a state actor.” Lugar v. Edmondson Oil Co., 457 U. S. 922, 937 (1982); see Flagg Bros., Inc. v. Brooks, 436 U. S. 149, 156 (1978). In this case, while it may fairly be said that private insurers act “ ‘with the knowledge of and pursuant to’ ” the state statute, ibid, (quoting Adickes v. S. H. Kress & Co., 398 U. S. 144, 162, n. 23 (1970)), thus satisfying the first requirement, respondents still must satisfy the second, whether the allegedly unconstitutional conduct is fairly attributable to the State.
Our approach to this latter question begins by identifying “the specific conduct of which the plaintiff complains.” Blum v. Yaretsky, 457 U. S., at 1004; see id., at 1003 (“Faithful adherence to the ‘state action’ requirement... requires careful attention to the gravamen of the plaintiff’s complaint”). Here, respondents named as defendants both public officials and a class of private insurers and self-insured employers. Also named is the director of the SWIF and the School District of Philadelphia, a municipal corporation. The complaint alleged that the state and private defendants, acting under color of state law and pursuant to the Act, deprived them of property in violation of due process by withholding payment for medical treatment without prior notice and an opportunity to be heard. All agree that the public officials responsible for administering the workers’ compensation system and the director of SWIF are state actors. See 139 F. 3d, at 167. Thus, the issue we address, in accordance with our cases, is whether a private insurer's decision to withhold payment for disputed medical treatment may be fairly attributable to the State so as to subject insurers to the constraints of the Fourteenth Amendment. Our answer to that question is “no.”
In cases involving extensive state regulation of private activity, we have consistently held that “[t]he mere fact that a business is subject to state regulation does not by itself convert its action into that of the State for purposes of the Fourteenth Amendment.” Jackson v. Metropolitan Edison Co., 419 U.S. 345, 350 (1974); see Blum, 457 U.S., at 1004. Faithful application of the state-action requirement in these cases ensures that the prerogative of regulating private business remains with the States and the representative branches, not the courts. Thus, the private insurers in this ease will not be held to constitutional standards unless “there is a sufficiently close nexus between the State and the challenged action of the regulated entity so that the action of the latter may be fairly treated as that of the State itself.” Ibid, (internal quotation marks omitted). Whether such a “close nexus” exists, our cases state, depends on whether the State “has exercised coercive power or has provided such significant encouragement, either overt or covert, that the choice must in law be deemed to be that of the State.” Ibid.; see Flagg Bros., supra, at 166; Jackson, supra, at 357; Moose Lodge No. 107 v. Irvis, 407 U. S. 163, 173 (1972); Adickes v. S. H. Kress & Co., supra, at 170. Action taken by private entities with the mere approval or acquiescence of the State is not state action. Blum, supra, at 1004-1005; Flagg Bros., supra, at 154-165; Jackson, supra, at 357.
Here, respondents do not assert that the decision to invoke utilization review should be attributed to the State because the State compels or is directly involved in that decision. Obviously the State is not so involved. It authorizes, but does not require, insurers to withhold payments for disputed medical treatment. The decision to withhold payment, like the decision to transfer Medicaid patients to a lower level of care in Blum, is made by concededly private parties, and “turns on... judgments made by private parties” without “standards... established by the State.” Blum, supra, at 1008.
Respondents do assert, however, that the decision to withhold payment to providers may be fairly attributable to the State because the State has “authorized” and “encouraged” it. Respondents’ primary argument in this regard is that, in amending the Act to provide for utilization review and to grant insurers an option they previously did not have, the State purposely “encouraged” insurers to withhold payments for disputed medical treatment. This argument reads too much into the State’s reform, and in any event cannot be squared with our cases.
We do not doubt that the State’s decision to provide insurers the option of deferring payment for unnecessary and unreasonable treatment pending review can in some sense be seen as encouraging them to do just that. But, as petitioners note, this kind of subtle encouragement is no more significant than that which inheres in the State’s creation or modification of any legal remedy. We have never held that the mere availability of a remedy for wrongful conduct, even when the private use of that remedy serves important public interests, so significantly encourages the private activity as to make the State responsible for it. See Tulsa Professional Collection Services, Inc. v. Pope, 485 U. S. 478, 485 (1988) (“Private use of state-sanetioned private remedies or procedures does not rise to the level of state action”); see also Lugar, 457 U. S., at 937; Flagg Bros., 436 U. S., at 165-166. It bears repeating that a finding of state action on this basis would be contrary to the “essential dichotomy,” Jackson, supra, at 349, between public and private acts that our cases have consistently recognized.
The State’s decision to allow insurers to withhold payments pending review can just as easily be seen as state inaction, or more accurately, a legislative decision not to intervene in a dispute between an insurer and an employee over whether a particular treatment is reasonable and necessary. See Flagg Bros., 436 U. S., at 164-165. Before the 1993 amendments, Pennsylvania restricted the ability of an insurer (after liability had been established, of course) to defer workers’ compensation medical benefits, including payment for unreasonable and unnecessary treatment, beyond 30 days of receipt of the bill. The 1993 amendments, in effect, restored to insurers the narrow option, historically exercised by employers and insurers before the adoption of Pennsylvania’s workers’ compensation law, to defer payment of a bill until it is substantiated. The most that can be said of the statutory scheme, therefore, is that whereas it previously prohibited insurers from withholding payment for disputed medical services, it no longer does so. Such permission of a private choice cannot support a finding of state action. As we have said before, our cases will not tolerate “the imposition of Fourteenth Amendment restraints on private action by the simple device of characterizing the State’s inaction as ‘authorization’ or ‘encouragement.’ ” Ibid.
Nor does the State’s role in creating, supervising, and setting standards for the URO process differ in any meaningful sense from the creation and administration of any forum for resolving disputes. While the decision of a URO, like that of any judicial official, may properly be considered state action, a private party’s mere use of the State’s dispute resolution machinery, without the “overt, significant assistance of state officials,” Tulsa, supra, at 486, cannot.
The State, in the course of administering a many-faceted remedial system, has shifted one facet from favoring the employees to favoring the employer. This sort of decision occurs regularly in legislative review of such systems. But it cannot be said that such a change “encourages” or “authorizes” the insurer’s actions as those terms are used in our state-action jurisprudence.
We also reject the notion, relied upon by the Court of Appeals, that the challenged decisions are state action because insurers must first obtain “authorization” or “permission” from the Bureau before withholding payment. See 139 F. 3d, at 168. As described in our earlier summary of the statute and regulations, the Bureau’s participation is limited to requiring insurers to file “a form prescribed by the Bureau,” 84 Pa. Code § 127.452, processing the request for technical compliance, and then forwarding the matter to a URO and informing the parties that utilization review has been requested. In Blum, we rejected the notion that the State, “by requiring completion of a form,” 457 U. S., at 1007, is responsible for the private party’s decision. The additional “paper shuffling” performed by the Bureau here in response to an insurers’ request does not alter that conclusion.
Respondents next contend that state action is present because the State has delegated to insurers “powers traditionally exclusively reserved to the State.” Jackson, 419 U. S., at 352. Their argument here is twofold. Relying on West v. Atkins, 487 U. S. 42 (1988), respondents first argue that workers’ compensation benefits are state-mandated “public benefits,” and that the State has delegated the provision of these “public benefits” to private insurers. They also contend that the State has delegated to insurers the traditionally exclusive government function of determining whether and under what circumstances an injured worker’s medical benefits may be suspended. The Court of Appeals apparently agreed on both points, stating that insurers “providing public benefits which honor State entitlements... become an arm of the State, fulfilling a uniquely governmental obligation,” 139 F. 3d, at 168, and that “[t]he right to invoke the supersedeas, or to stop payments, is a power that traditionally was held in the hands of the State,” ibid.
We think neither argument has merit. West is readily distinguishable: There the State was constitutionally obligated to provide medical treatment to injured inmates, and the delegation of that traditionally exclusive public function to a private physician gave rise to a finding of state action. See 487 U. S., at 54-56. Here, on the other hand, nothing in Pennsylvania’s Constitution or statutory scheme obligates the State to provide either medical treatment or workers’ compensation benefits to injured workers. See Blum, supra, at 1011. Instead, the State’s workers’ compensation law imposes that obligation on employers. This case is therefore not unlike Jackson, supra, where we noted that “while the Pennsylvania statute imposes an obligation to furnish service on regulated utilities, it imposes no such obligation on the State.” Id., at 353; see also San Francisco Arts & Athletics, Inc. v. United States Olympic Comm., 483 U. S. 522, 544 (1987) (“The fact ‘[t]hat a private entity performs a function which serves the public does not make its acts [governmental] action’”) (quoting Rendell-Baker v. Kohn, 457 U. S. 830, 842 (1982)).
Nor is there any merit in respondents’ argument that the State has delegated to insurers the traditionally exclusive governmental function of deciding whether to suspend payment for disputed medical treatment. Historical practice, as well as the state statutory scheme, does not support respondents’ characterization. It is no doubt true that before the 1993 amendments an insurer who sought to withhold payment for disputed medical treatment was required to petition the Bureau, and could withhold payment only upon a favorable ruling by a workers’ compensation judge, and then only for prospective treatment.
But before Pennsylvania ever adopted its workers’ compensation law, an insurer under contract with an employer to pay for its workers’ reasonable and necessary medical expenses could withhold payment, for any reason or no reason, without any authorization or involvement of the State. The insurer, of course, might become liable to the employer (or its workers) if the refusal to pay breached the contract or constituted “bad faith,” but the obligation to pay would only arise after the employer had initiated a claim and reduced it to a judgment. That Pennsylvania first recognized an insurer’s traditionally private prerogative to withhold payment, then restricted it, and now (in one limited respect) has restored it, cannot constitute the delegation of a traditionally exclusive public function. Like New York in Flagg Bros., Pennsylvania “has done nothing more than authorize (and indeed limit) — without participation by any public official— what [private insurers] would tend to do, even in the absence of such authorization,” i. e., withhold payment for disputed medical treatment pending a determination that the treatment is, in fact, reasonable and necessary. 436 U. S., at 162, n. 12.
The Court of Appeals, in response to the various arguments advanced by respondents, seems to have figuratively thrown up its hands and fallen back on language in our decision in Burton v. Wilmington Parking Authority, 365 U. S. 715 (1961). The Pennsylvania system, that court said, “inextricably entangles the insurance companies in a partnership with the Commonwealth such that they become an integral part of the state in administering the statutory scheme.” 139 F. 3d, at 170. Relying on Burton, respondents urge us to affirm the Court of Appeals’ holding under a “joint participation” theory of state action.
Burton was one of our early eases dealing with “state action” under the Fourteenth Amendment, and later cases have refined the vague “joint participation” test embodied in that case. Blum and Jackson, in particular, have established that “privately owned enterprises providing services that the State would not necessarily provide, even though they are extensively regulated, do not fall within the ambit of Burton.” Blum, 457 U. S., at 1011; see Jackson, supra, at 357-358. Here, workers’ compensation insurers are at least as extensively regulated as the private nursing facilities in Blum and the private utility in Jackson. Like those cases, though, the state statutory and regulatory scheme leaves the challenged decisions to the judgment of insurers.
Respondents also rely on Lugar v. Edmondson 457 U. S. 922 (1982), whieh contains general language about “joint participation” as a test for state action. But, as the Lugar opinion itself makes clear, its language must not be torn from the

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条. North Carolina U.S. Circuit for (all) District(s) of North Carolina
当. Ohio U.S. Circuit for (all) District(s) of Ohio
情. Oregon U.S. Circuit for the District of Oregon
口. Pennsylvania U.S. Circuit for (all) District(s) of Pennsylvania
合. Rhode Island U.S. Circuit for the District of Rhode Island
车. South Carolina U.S. Circuit for the District of South Carolina
实. Tennessee U.S. Circuit for (all) District(s) of Tennessee
组. Texas U.S. Circuit for (all) District(s) of Texas
版. Vermont U.S. Circuit for the District of Vermont
周. Virginia U.S. Circuit for (all) District(s) of Virginia
址. West Virginia U.S. Circuit for (all) District(s) of West Virginia
记. Wisconsin U.S. Circuit for (all) District(s) of Wisconsin
二. Wyoming U.S. Circuit for the District of Wyoming
同. Circuit Court of the District of Columbia
业. Nebraska U.S. Circuit for the District of Nebraska
权. Colorado U.S. Circuit for the District of Colorado
其. Washington U.S. Circuit for (all) District(s) of Washington
进. Idaho U.S. Circuit Court for (all) District(s) of Idaho
试. Montana U.S. Circuit Court for (all) District(s) of Montana
验. Utah U.S. Circuit Court for (all) District(s) of Utah
料. South Dakota U.S. Circuit Court for (all) District(s) of South Dakota
传. North Dakota U.S. Circuit Court for (all) District(s) of North Dakota
述. Oklahoma U.S. Circuit Court for (all) District(s) of Oklahoma
集. Court of Private Land Claims
多. United States Supreme Court
Answer:

Answer: 重