A flagged IME result is a request for more information, not a refusal. Panel physicians can't refer you to a specialist unless IRCC asks, except when a chest X-ray suggests active TB; most of the extra time comes from testing and specialist availability, not IRCC's review.

An IME is valid for exactly 12 months from the date of your initial exam, not from when you submit your application or receive your ITA, so tracking that date is the easiest way to avoid a surprise re-medical request. Mark the date on your calendar and check your eMedical account regularly.