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Big Tobacco beats Korea's national health insurer. Again.

Published: 15 Jan. 2026, 19:15

The National Health Insurance Service office in Jongno District, central Seoul [YONHAP]

Korea’s National Health Insurance Service (NHIS) lost again on appeal in its roughly 50 billion won ($34 million) damages suit against tobacco companies, marking a second-instance conclusion nearly 12 years after it first filed the case.

The Seoul High Court ruled Thursday against the NHIS in its damages claim against KT&G, Philip Morris Korea and British American Tobacco Korea, among others.

“The plaintiff was fulfilling obligations under the insurance law and disbursing funds, so it is difficult to say that any legal interest of the plaintiff was infringed,” the court said, adding that it was hard to find illegality in the lower court ruling that did not recognize the NHIS’s direct right to seek damages.

The key issues in the trial are whether there is a causal relationship between smoking and the onset of lung cancer; whether tobacco companies concealed or downplayed the addictive nature of cigarettes; whether there were any design or labeling defects in their cigarettes; and whether the NHIS, rather than individual smokers, can claim damages.

The NHIS has argued that defects in cigarettes imported, manufactured and sold by the tobacco companies — along with the companies’ wrongful conduct — caused some 3,460 smokers to develop cancers, including small cell lung cancer, squamous cell lung cancer and squamous cell carcinoma of the larynx. It said it paid a total of 53.3 billion won in insurance benefits related to those patients between 2003 and 2012.

Saying it suffered losses by paying those benefits due to the tobacco companies’ alleged wrongful conduct, the NHIS filed the suit in April 2014, arguing the companies were jointly liable and must pay damages equivalent to 53.3 billion won.

After six years of hearings, the lower court ruled against the NHIS in November 2020.

Smokers gather at a smoking zone on May 29 in Seoul. [NEWS1]

The lower court said the NHIS’s payments to medical institutions were the fulfillment of its legal obligations under the National Health Insurance Act and the execution of funds collected or supported under that law — meaning the benefit payments were a duty, not a compensable loss.

It also held that the smokers themselves did not have valid claims for damages against the tobacco companies, citing difficulty in finding defects in the cigarettes and a lack of proof of individual causation between smoking and lung cancer.

“The evidence submitted by the NHIS only shows facts such as that the subjects in this case had histories of smoking one pack a day for at least 20 years and were diagnosed with disease,” the lower court said.

On Thursday, the higher court again rejected the plaintiffs’ argument. They argued that the link between smoking and lung cancer found in studies should be enough to assume smoking caused the disease, and that it should be up to the defendants to prove the cancer came from something else.

But the court said epidemiological research has limits, noting that it does not, in fact, provide precise information about what caused a particular individual’s disease.

A convenience store worker is seen in front of a display of cigarettes and vapes at a store in Seoul on June 12. [YONHAP]

The court referred to a Supreme Court ruling that even if studies show a general link between smoking and diseases like lung cancer, simply proving that a person smoked and later got lung cancer isn’t enough on its own to prove that smoking caused their cancer.

It said that additional circumstances must be examined, including when the person smoked and for how long, when the lung cancer developed, the person’s health condition before smoking, lifestyle, changes in their medical condition and family medical history.

The state health insurer also initially asked the court to ease the burden of proving causation, as is done in environmental pollution lawsuits.

But the court rejected that request, saying that, unlike in pollution cases, carcinogens reach smokers as a result of their own decision to buy and smoke cigarettes. During the appeal, the NHIS submitted additional in-depth data on heavy smokers and focused on proving the causal link between smoking and lung cancer and on highlighting manufacturers’ responsibility.

Even so, the court said it would be reasonable, when assessing individual causation, to give significant weight to the epidemiological correlation between smoking and lung cancer and to the fact that the plaintiffs in this case had smoked one pack a day for at least 20 years and had been diagnosed with lung or laryngeal cancer.

Jung Ki-suck, chairman of the National Health Insurance Service, speaks to reporters on Jan. 15 at the Seoul High Court in Seocho District, southern Seoul, about the NHIS’s loss in an appeals court ruling in its large-scale damages lawsuit against major tobacco companies. [YONHAP]

However, because the plaintiffs had failed to prove any unlawful act by the defendants, the court said it could not recognize liability for damages and therefore would not further examine individual causation.

The state health insurer also argued that failing to produce cigarettes with reduced nicotine content, as well as the use of additives and ventilated filters, amounted to design defects.

But the court found it hard to see a design flaw in not lowering the amount of nicotine naturally contained in tobacco leaves to a certain level. It also said it was difficult to generalize that cigarettes without additives are safer, or that cigarettes with simple filters are less harmful than those with ventilated filters.

On claims that cigarette packs did not correctly state the health risks and addictiveness of smoking, the court said that simply not adding extra explanations or warning labels beyond the mandated warnings could not be considered a labeling defect. It added that, given how widely known the harmful and addictive nature of cigarettes is in society, the companies could not be seen as having committed an unlawful act by deceiving the public or concealing that information.

Immediately after the ruling, the NHIS said it would appeal to the Supreme Court.

“I did not expect the gap between science and the law to be this wide,” said Jung Ki-suck, head of the state health insurer. “It is heartbreaking that the courts still take such a reserved stance on the harms of smoking.”

This article was originally written in Korean and translated by a bilingual reporter with the help of generative AI tools. It was then edited by a native English-speaking editor. All AI-assisted translations are reviewed and refined by our newsroom.
BY HYEON YE-SEUL, KIM BO-REUM [[email protected]]