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Appellate court set to rule on Korea's 'big tobacco' case over cancer coverage

Published: 21 May. 2025, 15:40 Updated: 21 May. 2025, 16:35

Cigarettes on sale at a convenience store in Seoul in December 2020. [YONHAP]

Corporate freedom or the duty to protect people's health? A high-stakes legal battle between the National Health Insurance Service (NHIS) and three tobacco companies — KT&G, Philip Morris Korea and BAT Korea — is approaching a key turning point after 11 years.

An appellate court is expected to deliver a ruling soon following the final hearing scheduled for Thursday. Framed as a clash between the public’s right to health and corporate freedom, the case, in which the NHIS demands compensation from the three firms for cancer treatment, has drawn strong backing from the medical and academic communities.

The NHIS is seeking to overturn a 2020 lower court ruling that dismissed its claim of 53.3 billion won ($38.4 million) in compensation for medical costs it paid for 3,465 lung and laryngeal cancer patients who smoked for over 30 years.

But officials say the case’s implications go far beyond monetary damages, potentially shaping future tobacco control policies and legal precedents on public health.

A person holds a pack of cigarettes at a convenience store in Seoul on Dec. 23 last year. [YONHAP]

Core legal issues

The case began in 2014, with three main points of contention: whether the tobacco companies bear some responsibility under product liability and tort law, whether there is scientific causality between smoking and cancer and whether the NHIS has the right to claim damages directly.

The NHIS argues that the tobacco companies failed to reduce the risks associated with their products and are liable for the health consequences caused by smoking. It claims the link between smoking and cancer is medically clear.

The companies counter that the NHIS must prove the absence of other cancer risk factors in each case. They also argue that they have complied with all legal requirements regarding product warning signs.

The lower court sided with the tobacco firms in 2020, citing a lack of evidence proving that smoking was the exclusive cause of the patients' cancers. The NHIS appealed, and 11 hearings have been held since 2021. The upcoming 12th session will be the final hearing.

E-cigarettes displayed in a vending machine in Mapo District, western Seoul, on May 9. [YONHAP]

Focusing on scientific causation

To strengthen its case, the NHIS has concentrated on proving the direct causality between smoking and cancer.

It submitted additional documentation to address the lower court’s concern that alternative risk factors such as lifestyle and family history were not ruled out. The agency narrowed its focus to 1,467 patients with no known risk factors other than smoking.

A recent study presented by the NHIS claims that genetic factors play less than a 1 percent role in the onset of lung and laryngeal cancers, whereas smoking is the dominant contributor.

“We’ve submitted 495 pieces of evidence across both trials and secured over 3,000 medical records,” Lim Hyun-jung, director of the NHIS legal support division, said at a recent debate panel. “While both health rights and corporate freedom matter, clear harm to public health must take precedence. We hope the court makes a thorough and fair assessment.”

NHIS President Jung Ki-suck, a respiratory disease specialist, plans to attend Thursday’s hearing to personally emphasize the health risks of smoking and the accountability of the tobacco industry. In the previous hearing, he warned that failing to hold tobacco firms responsible would undermine the health rights of society at large.

A banner saying Seoul Station Plaza will be designated a nonsmoking zone [JUNG DISTRICT OFFICE]

Support from the medical community

The general health expert community is, obviously, on the NHIS's side.

Medical organizations, including the National Cancer Center and 17 health care associations, have publicly backed the NHIS in a joint statement accusing tobacco companies of deliberately obscuring the link between smoking and disease, calling smoking a “designed addiction” rather than a personal choice.

"Smoking is the single most direct cause of lung cancer," said the Korean Association for Lung Cancer and others in similar statements. "We demand a scientifically grounded judgment in the name of social justice."

Public health advocates say a favorable ruling is essential to protect future generations who are exposed to new tobacco products.

“Tobacco companies are aggressively marketing new products to attract youth and women as new consumer bases,” said Kim Hyeon-suk, a nursing professor at Shinhan University and president of the Korean Society for Research on Nicotine and Tobacco. “The court must send a strong message to counter these trends.”

The NHIS estimates that health insurance spending related to smoking reached 3.86 trillion won in 2023 alone.

Cigarette butts pile up in a gutter near Gangnam Station in southern Seoul on June 23, 2023. [YONHAP]

Legal hurdles remain

So far, all lawsuits filed by individuals against tobacco firms in Korea have failed. In contrast, governments and victims in the United States and Canada have reached multibillion-dollar settlements with tobacco companies.

Still, experts caution that overturning the first trial’s legal conclusions may be difficult without new “smoking gun” evidence such as internal documents or whistle-blowers from the tobacco companies.

Lee Sung-kyu, head of the Korea Center for Tobacco Control Research and Education, said proving that the plaintiffs specifically used products from the three companies remains a challenge.

“Without access to internal records, product liability will be hard to establish,” said Lee. “Many Koreans still mistakenly believe KT&G is a public enterprise. Public awareness is crucial. The NHIS needs to educate the public and gain broad support to improve its chances."

The three tobacco companies have not issued any public statements regarding the ongoing litigation.

Translated from the JoongAng Ilbo using generative AI and edited by Korea JoongAng Daily staff.
BY JUNG JONG-HOON [[email protected]]