The National Health Insurance Service(NHIS) clashed in court with tobacco firms as both sides presented their final arguments in the so-called cigarette lawsuit, in which the state health insurer is seeking 53-point-three billion won, or around 38-point-eight million U.S. dollars.

The 12th hearing in the appeals case took place at the Seoul High Court on Thursday, with defendants KT&G, Korea Philip Morris, BAT Korea and other tobacco firms questioning the causal relationship between smoking and disease.

NHIS Chairman Jung Ki-suck, a respiratory medicine specialist, testified that the state health insurer submitted 121 pieces of evidence supporting the causal relationship between smoking and lung cancer.

The NHIS also presented data showing that for people who smoke for more than 30 years or those who smoke one pack a day for more than 20 years, the risk of developing small-cell lung cancer is 54 times higher.

But the tobacco companies countered that the lower court’s ruling in their favor should stand, saying there are other factors besides smoking that cause lung cancer and that smokers are free to choose whether to smoke or quit smoking.